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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Plasma exchange for renal vasculitis and idiopathic rapidly progressive glomerulonephritis: a meta-analysis</title>
<author><name sortKey="Walsh, Michael" sort="Walsh, Michael" uniqKey="Walsh M" first="Michael" last="Walsh">Michael Walsh</name>
<affiliation><nlm:aff id="A1"> Department of Clinical Epidemiology and Biostatistics McMaster University, Hamilton, Canada</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A2"> Vasculitis and Lupus Clinic Addenbrooke’s Hospital, Cambridge, UK</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Catapano, Fausta" sort="Catapano, Fausta" uniqKey="Catapano F" first="Fausta" last="Catapano">Fausta Catapano</name>
<affiliation><nlm:aff id="A2"> Vasculitis and Lupus Clinic Addenbrooke’s Hospital, Cambridge, UK</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Szpirt, Wladimir" sort="Szpirt, Wladimir" uniqKey="Szpirt W" first="Wladimir" last="Szpirt">Wladimir Szpirt</name>
<affiliation><nlm:aff id="A3"> Department of Nephrology Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Thorlund, Kristian" sort="Thorlund, Kristian" uniqKey="Thorlund K" first="Kristian" last="Thorlund">Kristian Thorlund</name>
<affiliation><nlm:aff id="A1"> Department of Clinical Epidemiology and Biostatistics McMaster University, Hamilton, Canada</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Bruchfeld, Annette" sort="Bruchfeld, Annette" uniqKey="Bruchfeld A" first="Annette" last="Bruchfeld">Annette Bruchfeld</name>
<affiliation><nlm:aff id="A4"> Deptartment of Renal Medicine Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Guillevin, Loic" sort="Guillevin, Loic" uniqKey="Guillevin L" first="Loic" last="Guillevin">Loic Guillevin</name>
<affiliation><nlm:aff id="A5"> Hopital Cochin, Assistance Publique, Hopitaux de Paris, Universite Paris Descartes, Paris, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Haubitz, Marion" sort="Haubitz, Marion" uniqKey="Haubitz M" first="Marion" last="Haubitz">Marion Haubitz</name>
<affiliation><nlm:aff id="A6"> Department of Nephrology and Hypertension Hannover School of Medicine, Hannover, Germany</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Merkel, Peter A" sort="Merkel, Peter A" uniqKey="Merkel P" first="Peter A." last="Merkel">Peter A. Merkel</name>
<affiliation><nlm:aff id="A7"> Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit Boston University School of Medicine, Boston, USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Peh, Chen Au" sort="Peh, Chen Au" uniqKey="Peh C" first="Chen Au" last="Peh">Chen Au Peh</name>
<affiliation><nlm:aff id="A8"> Renal Unit Royal Adelaide Hospital, Adelaide, Australia</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Pusey, Charles" sort="Pusey, Charles" uniqKey="Pusey C" first="Charles" last="Pusey">Charles Pusey</name>
<affiliation><nlm:aff id="A9"> Renal Section, Division of Medicine, Imperial College London, Hammersmith Hospital, London, UK</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Jayne, David" sort="Jayne, David" uniqKey="Jayne D" first="David" last="Jayne">David Jayne</name>
<affiliation><nlm:aff id="A2"> Vasculitis and Lupus Clinic Addenbrooke’s Hospital, Cambridge, UK</nlm:aff>
</affiliation>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">PMC</idno>
<idno type="pmid">21194817</idno>
<idno type="pmc">3062650</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3062650</idno>
<idno type="RBID">PMC:3062650</idno>
<idno type="doi">10.1053/j.ajkd.2010.10.049</idno>
<date when="2010">2010</date>
<idno type="wicri:Area/Pmc/Corpus">001462</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001462</idno>
</publicationStmt>
<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Plasma exchange for renal vasculitis and idiopathic rapidly progressive glomerulonephritis: a meta-analysis</title>
<author><name sortKey="Walsh, Michael" sort="Walsh, Michael" uniqKey="Walsh M" first="Michael" last="Walsh">Michael Walsh</name>
<affiliation><nlm:aff id="A1"> Department of Clinical Epidemiology and Biostatistics McMaster University, Hamilton, Canada</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A2"> Vasculitis and Lupus Clinic Addenbrooke’s Hospital, Cambridge, UK</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Catapano, Fausta" sort="Catapano, Fausta" uniqKey="Catapano F" first="Fausta" last="Catapano">Fausta Catapano</name>
<affiliation><nlm:aff id="A2"> Vasculitis and Lupus Clinic Addenbrooke’s Hospital, Cambridge, UK</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Szpirt, Wladimir" sort="Szpirt, Wladimir" uniqKey="Szpirt W" first="Wladimir" last="Szpirt">Wladimir Szpirt</name>
<affiliation><nlm:aff id="A3"> Department of Nephrology Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Thorlund, Kristian" sort="Thorlund, Kristian" uniqKey="Thorlund K" first="Kristian" last="Thorlund">Kristian Thorlund</name>
<affiliation><nlm:aff id="A1"> Department of Clinical Epidemiology and Biostatistics McMaster University, Hamilton, Canada</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Bruchfeld, Annette" sort="Bruchfeld, Annette" uniqKey="Bruchfeld A" first="Annette" last="Bruchfeld">Annette Bruchfeld</name>
<affiliation><nlm:aff id="A4"> Deptartment of Renal Medicine Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Guillevin, Loic" sort="Guillevin, Loic" uniqKey="Guillevin L" first="Loic" last="Guillevin">Loic Guillevin</name>
<affiliation><nlm:aff id="A5"> Hopital Cochin, Assistance Publique, Hopitaux de Paris, Universite Paris Descartes, Paris, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Haubitz, Marion" sort="Haubitz, Marion" uniqKey="Haubitz M" first="Marion" last="Haubitz">Marion Haubitz</name>
<affiliation><nlm:aff id="A6"> Department of Nephrology and Hypertension Hannover School of Medicine, Hannover, Germany</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Merkel, Peter A" sort="Merkel, Peter A" uniqKey="Merkel P" first="Peter A." last="Merkel">Peter A. Merkel</name>
<affiliation><nlm:aff id="A7"> Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit Boston University School of Medicine, Boston, USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Peh, Chen Au" sort="Peh, Chen Au" uniqKey="Peh C" first="Chen Au" last="Peh">Chen Au Peh</name>
<affiliation><nlm:aff id="A8"> Renal Unit Royal Adelaide Hospital, Adelaide, Australia</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Pusey, Charles" sort="Pusey, Charles" uniqKey="Pusey C" first="Charles" last="Pusey">Charles Pusey</name>
<affiliation><nlm:aff id="A9"> Renal Section, Division of Medicine, Imperial College London, Hammersmith Hospital, London, UK</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Jayne, David" sort="Jayne, David" uniqKey="Jayne D" first="David" last="Jayne">David Jayne</name>
<affiliation><nlm:aff id="A2"> Vasculitis and Lupus Clinic Addenbrooke’s Hospital, Cambridge, UK</nlm:aff>
</affiliation>
</author>
</analytic>
<series><title level="j">American journal of kidney diseases : the official journal of the National Kidney Foundation</title>
<idno type="ISSN">0272-6386</idno>
<idno type="eISSN">1523-6838</idno>
<imprint><date when="2010">2010</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title>
<p id="P2">Plasma exchange may be effective adjunctive treatment for renal vasculitis. We performed a systematic review and meta-analysis of randomized control trials of plasma exchange for renal vasculitis.</p>
</sec>
<sec id="S2"><title>Study Design</title>
<p id="P3">Systematic review and meta-analysis of manuscripts identified from electronic databases, bibliographies, and studies identified by experts. Data was abstracted in parallel by two reviewers.</p>
</sec>
<sec id="S3"><title>Setting & Population</title>
<p id="P4">Adults with idiopathic renal vasculitis or rapidly progressive glomerulonephritis</p>
</sec>
<sec id="S4"><title>Selection Criteria for Studies</title>
<p id="P5">Randomized controlled trials that compared standard care with standard care plus adjuvant plasma exchange in adult patients with either renal vasculitis or idiopathic rapidly progressive glomerulonephritis.</p>
</sec>
<sec id="S5"><title>Intervention</title>
<p id="P6">Adjuvant plasma exchange</p>
</sec>
<sec id="S6"><title>Outcome</title>
<p id="P7">Composite of end-stage renal disease or death.</p>
</sec>
<sec id="S7"><title>Results</title>
<p id="P8">We identified 9 trials including 387 patients. In a fixed-effects model the pooled relative risk of end-stage renal disease or death was 0.80 for patients treated with adjunctive plasma exchange compared to standard care alone (95% confidence interval 0.65 to 0.99; p=0.04). No significant heterogeneity was detected (p=0.5; I<sup>2</sup>
=0%). The effect of plasma exchange did not differ significantly across the range of baseline serum creatinine values (p=0.7) or number of plasma exchange treatments (p=0.8). The relative risk for end-stage renal disease was 0.64 (95% confidence interval 0.47 to 0.88; p=0.006) while the relative risk for death alone was 1.01 (95% confidence interval 0.71 to 1.4; p=0.9).</p>
</sec>
<sec id="S8"><title>Limitations</title>
<p id="P9">Although the primary result was statistically significant, there is insufficient statistical information to reliable determine if plasma exchange reduces the composite of end-stage renal disease or death.</p>
</sec>
<sec id="S9"><title>Conclusions</title>
<p id="P10">Plasma exchange may reduce the composite endpoint of end-stage renal disease or death in renal vasculitis. Further trials are required given the limited data available.</p>
</sec>
</div>
</front>
</TEI>
<pmc article-type="research-article" xml:lang="EN"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">8110075</journal-id>
<journal-id journal-id-type="pubmed-jr-id">423</journal-id>
<journal-id journal-id-type="nlm-ta">Am J Kidney Dis</journal-id>
<journal-title>American journal of kidney diseases : the official journal of the National Kidney Foundation</journal-title>
<issn pub-type="ppub">0272-6386</issn>
<issn pub-type="epub">1523-6838</issn>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">21194817</article-id>
<article-id pub-id-type="pmc">3062650</article-id>
<article-id pub-id-type="doi">10.1053/j.ajkd.2010.10.049</article-id>
<article-id pub-id-type="manuscript">NIHMS262098</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Plasma exchange for renal vasculitis and idiopathic rapidly progressive glomerulonephritis: a meta-analysis</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Walsh</surname>
<given-names>Michael</given-names>
</name>
<degrees>MD, MSc</degrees>
<xref rid="A1" ref-type="aff">1</xref>
<xref rid="A2" ref-type="aff">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Catapano</surname>
<given-names>Fausta</given-names>
</name>
<degrees>MD, PhD</degrees>
<xref rid="A2" ref-type="aff">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Szpirt</surname>
<given-names>Wladimir</given-names>
</name>
<degrees>MD</degrees>
<xref rid="A3" ref-type="aff">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Thorlund</surname>
<given-names>Kristian</given-names>
</name>
<degrees>MSc</degrees>
<xref rid="A1" ref-type="aff">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bruchfeld</surname>
<given-names>Annette</given-names>
</name>
<degrees>MD, PhD</degrees>
<xref rid="A4" ref-type="aff">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Guillevin</surname>
<given-names>Loic</given-names>
</name>
<degrees>MD</degrees>
<xref rid="A5" ref-type="aff">5</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Haubitz</surname>
<given-names>Marion</given-names>
</name>
<xref rid="A6" ref-type="aff">6</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Merkel</surname>
<given-names>Peter A.</given-names>
</name>
<degrees>MD, MPH</degrees>
<xref rid="A7" ref-type="aff">7</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Peh</surname>
<given-names>Chen Au</given-names>
</name>
<degrees>MD, PhD</degrees>
<xref rid="A8" ref-type="aff">8</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Pusey</surname>
<given-names>Charles</given-names>
</name>
<degrees>DSc</degrees>
<xref rid="A9" ref-type="aff">9</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Jayne</surname>
<given-names>David</given-names>
</name>
<degrees>MD</degrees>
<xref rid="A2" ref-type="aff">2</xref>
</contrib>
</contrib-group>
<aff id="A1"><label>1</label>
Department of Clinical Epidemiology and Biostatistics McMaster University, Hamilton, Canada</aff>
<aff id="A2"><label>2</label>
Vasculitis and Lupus Clinic Addenbrooke’s Hospital, Cambridge, UK</aff>
<aff id="A3"><label>3</label>
Department of Nephrology Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark</aff>
<aff id="A4"><label>4</label>
Deptartment of Renal Medicine Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden</aff>
<aff id="A5"><label>5</label>
Hopital Cochin, Assistance Publique, Hopitaux de Paris, Universite Paris Descartes, Paris, France</aff>
<aff id="A6"><label>6</label>
Department of Nephrology and Hypertension Hannover School of Medicine, Hannover, Germany</aff>
<aff id="A7"><label>7</label>
Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit Boston University School of Medicine, Boston, USA</aff>
<aff id="A8"><label>8</label>
Renal Unit Royal Adelaide Hospital, Adelaide, Australia</aff>
<aff id="A9"><label>9</label>
Renal Section, Division of Medicine, Imperial College London, Hammersmith Hospital, London, UK</aff>
<author-notes><corresp id="FN1">Corresponding Author: Michael Walsh, Department of Clinical Epidemiology and Biostatistics, McMaster University, 1200 Main Street West, Hamilton, Ontario. <email>mwwalsh@ucalgary.ca</email>
; phone: 905-525-9140 ext 22876: facsimile: 905-524-3841</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>12</day>
<month>1</month>
<year>2011</year>
</pub-date>
<pub-date pub-type="epub"><day>30</day>
<month>12</month>
<year>2010</year>
</pub-date>
<pub-date pub-type="ppub"><month>4</month>
<year>2011</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>1</day>
<month>4</month>
<year>2012</year>
</pub-date>
<volume>57</volume>
<issue>4</issue>
<fpage>566</fpage>
<lpage>574</lpage>
<abstract><sec id="S1"><title>Background</title>
<p id="P2">Plasma exchange may be effective adjunctive treatment for renal vasculitis. We performed a systematic review and meta-analysis of randomized control trials of plasma exchange for renal vasculitis.</p>
</sec>
<sec id="S2"><title>Study Design</title>
<p id="P3">Systematic review and meta-analysis of manuscripts identified from electronic databases, bibliographies, and studies identified by experts. Data was abstracted in parallel by two reviewers.</p>
</sec>
<sec id="S3"><title>Setting & Population</title>
<p id="P4">Adults with idiopathic renal vasculitis or rapidly progressive glomerulonephritis</p>
</sec>
<sec id="S4"><title>Selection Criteria for Studies</title>
<p id="P5">Randomized controlled trials that compared standard care with standard care plus adjuvant plasma exchange in adult patients with either renal vasculitis or idiopathic rapidly progressive glomerulonephritis.</p>
</sec>
<sec id="S5"><title>Intervention</title>
<p id="P6">Adjuvant plasma exchange</p>
</sec>
<sec id="S6"><title>Outcome</title>
<p id="P7">Composite of end-stage renal disease or death.</p>
</sec>
<sec id="S7"><title>Results</title>
<p id="P8">We identified 9 trials including 387 patients. In a fixed-effects model the pooled relative risk of end-stage renal disease or death was 0.80 for patients treated with adjunctive plasma exchange compared to standard care alone (95% confidence interval 0.65 to 0.99; p=0.04). No significant heterogeneity was detected (p=0.5; I<sup>2</sup>
=0%). The effect of plasma exchange did not differ significantly across the range of baseline serum creatinine values (p=0.7) or number of plasma exchange treatments (p=0.8). The relative risk for end-stage renal disease was 0.64 (95% confidence interval 0.47 to 0.88; p=0.006) while the relative risk for death alone was 1.01 (95% confidence interval 0.71 to 1.4; p=0.9).</p>
</sec>
<sec id="S8"><title>Limitations</title>
<p id="P9">Although the primary result was statistically significant, there is insufficient statistical information to reliable determine if plasma exchange reduces the composite of end-stage renal disease or death.</p>
</sec>
<sec id="S9"><title>Conclusions</title>
<p id="P10">Plasma exchange may reduce the composite endpoint of end-stage renal disease or death in renal vasculitis. Further trials are required given the limited data available.</p>
</sec>
</abstract>
<kwd-group><kwd>vasculitis</kwd>
<kwd>glomerulonephritis</kwd>
<kwd>plasma exchange</kwd>
<kwd>meta-analysis</kwd>
</kwd-group>
<contract-num rid="AR1">U54 AR057319-08
||AR</contract-num>
<contract-sponsor id="AR1">National Institute of Arthritis and Musculoskeletal and Skin Diseases : NIAMS</contract-sponsor>
</article-meta>
</front>
</pmc>
</record>
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