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Meta-Analysis
. 2011 Apr;57(4):566-74.
doi: 10.1053/j.ajkd.2010.10.049. Epub 2010 Dec 30.

Plasma exchange for renal vasculitis and idiopathic rapidly progressive glomerulonephritis: a meta-analysis

Michael Walsh  1 , Fausta Catapano, Wladimir Szpirt, Kristian Thorlund, Annette Bruchfeld, Loic Guillevin, Marion Haubitz, Peter A Merkel, Chen Au Peh, Charles Pusey, David Jayne
Affiliations
Meta-Analysis

Plasma exchange for renal vasculitis and idiopathic rapidly progressive glomerulonephritis: a meta-analysis

Michael Walsh et al. Am J Kidney Dis. 2011 Apr.

Abstract

Background: Plasma exchange may be effective adjunctive treatment for renal vasculitis. We performed a systematic review and meta-analysis of randomized controlled trials of plasma exchange for renal vasculitis.

Study design: Systematic review and meta-analysis of articles identified from electronic databases, bibliographies, and studies identified by experts. Data were abstracted in parallel by 2 reviewers.

Setting & population: Adults with idiopathic renal vasculitis or rapidly progressive glomerulonephritis.

Selection criteria for studies: 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.

Intervention: Adjuvant plasma exchange.

Outcome: Composite of end-stage renal disease or death.

Results: We identified 9 trials including 387 patients. In a fixed-effects model, the pooled RR for end-stage renal disease or death was 0.80 for patients treated with adjunctive plasma exchange compared with standard care alone (95% CI, 0.65-0.99; P = 0.04). No significant heterogeneity was detected (P = 0.5; I(2) = 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 RR for end-stage renal disease was 0.64 (95% CI, 0.47-0.88; P = 0.006), whereas the RR for death alone was 1.01 (95% CI, 0.71-1.4; P = 0.9).

Limitations: Although the primary result was statistically significant, there is insufficient statistical information to reliably determine whether plasma exchange decreases the composite of end-stage renal disease or death.

Conclusions: Plasma exchange may decrease the composite end point of end-stage renal disease or death in patients with renal vasculitis. Additional trials are required given the limited data available.

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Conflict of interest statement

Disclosures

Michael Walsh has no conflicts of interest to disclose.

Fausta Catapano has no conflicts of interest to disclose.

Wladimir Szpirt has no conflicts of interest to disclose.

Kristian Thorlund has no conflicts of interest to disclose.

Annette Bruchfeld has no conflicts of interest to disclose.

Loic Guillevin has no conflicts of interest to disclose.

Chen Au Peh has no conflicts of interest to disclose.

Peter Merkel has no conflicts of interest to disclose.

Charles Pusey has no conflicts of interest to disclose.

Marion Haubitz has no conflicts of interest to disclose.

David Jayne has no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Literature search and selection.
Figure 2
Figure 2
Forest plot of the effects of adjunctive plasma exchange (PLEX) on the composite endpoint of end-stage renal disease or death in patients with ANCA associated vasculitis.
Figure 3
Figure 3
Forest plot of the effects of adjunctive plasma exchange (PLEX) on the endpoint of death in patients with ANCA associated vasculitis.
Figure 4
Figure 4
Forest plot of the effects of adjunctive plasma exchange (PLEX) on the endpoint of end-stage renal disease in patients with ANCA associated vasculitis.
Figure 5
Figure 5
Results of a cumulative meta-analysis after the addition of a hypothetical trial, including 500 patients and demonstrating a 25% relative risk reduction, to the current meta-analysis results. The intersection of the Moderate Evidence and Cumulative Z-statistic lines demonstrates the number of patients required to achieve moderate evidence for the effect of PLEX.
See this image and copyright information in PMC

Comment in

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