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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
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