Kidney Histopathology Can Predict Kidney Function in ANCA-Associated Vasculitides with Acute Kidney Injury Treated with Plasma Exchanges - Université Paris Cité Accéder directement au contenu
Article Dans Une Revue Journal of the American Society of Nephrology Année : 2022

Kidney Histopathology Can Predict Kidney Function in ANCA-Associated Vasculitides with Acute Kidney Injury Treated with Plasma Exchanges

Dorian Nezam
  • Fonction : Auteur
Dimitri Titeca-Beauport
François Maurier
  • Fonction : Auteur
Hamza Sakhi
Didier Ducloux
Romain Paule
  • Fonction : Auteur
Jean-François Augusto
  • Fonction : Auteur
Julien Aniort
Aurélien Tiple
  • Fonction : Auteur
Cédric Rafat
  • Fonction : Auteur
Séverine Beaudreuil
  • Fonction : Auteur
Xavier Puechal
Pierre Gobert
  • Fonction : Auteur
Ziad Massy
Catherine Hanrotel
  • Fonction : Auteur
Stéphane Bally
  • Fonction : Auteur
Nihal Martis
Cécile-Audrey Durel
  • Fonction : Auteur
Geoffroy Desbuissons
  • Fonction : Auteur
Pascal Godmer
  • Fonction : Auteur
Aurélie Hummel
  • Fonction : Auteur
François Perrin
  • Fonction : Auteur
Antoine Neel
  • Fonction : Auteur
Claire de Moreuil
  • Fonction : Auteur
Tiphaine Goulenok
  • Fonction : Auteur
Dominique Guerrot
Steven Grange
  • Fonction : Auteur
Aurélie Foucher
  • Fonction : Auteur
Alban Deroux
  • Fonction : Auteur
Carole Cordonnier
  • Fonction : Auteur
Céline Guilbeau-Frugier
Anne Modesto-Segonds
  • Fonction : Auteur
Dominique Nochy
  • Fonction : Auteur
Laurent Daniel
  • Fonction : Auteur
Anissa Moktefi
Marion Rabant
Loïc Guillevin
  • Fonction : Auteur
Alexis Regent
  • Fonction : Auteur
Benjamin Terrier

Résumé

Background Data from the PEXIVAS trial challenged the role of plasma exchange (PLEX) in ANCA-associated vasculitides (AAV). We aimed to describe kidney biopsy from patients with AAV treated with PLEX, evaluate whether histopathologic findings could predict kidney function, and identify which patients would most benefit from PLEX. Methods We performed a multicenter, retrospective study on 188 patients with AAV and AKI treated with PLEX and 237 not treated with PLEX. The primary outcome was mortality or KRT at 12 months (M12). Results No significant benefit of PLEX for the primary outcome was found. To identify patients benefitting from PLEX, we developed a model predicting the average treatment effect of PLEX for an individual depending on covariables. Using the prediction model, 223 patients had a better predicted outcome with PLEX than without PLEX, and 177 of them had >5% increased predicted probability with PLEX compared with without PLEX of being alive and free from KRT at M12, which defined the PLEX-recommended group. Risk difference for death or KRT at M12 was significantly lower with PLEX in the PLEX-recommended group (−15.9%; 95% CI, −29.4 to −2.5) compared with the PLEX not recommended group (−4.8%; 95% CI, 14.9 to 5.3). Microscopic polyangiitis, MPO-ANCA, higher serum creatinine, crescentic and sclerotic classes, and higher Brix score were more frequent in the PLEX-recommended group. An easy to use score identified patients who would benefit from PLEX. The average treatment effect of PLEX for those with recommended treatment corresponded to an absolute risk reduction for death or KRT at M12 of 24.6%. Conclusions PLEX was not associated with a better primary outcome in the whole study population, but we identified a subset of patients who could benefit from PLEX. However, these findings must be validated before utilized in clinical decision making.

Dates et versions

hal-03579125 , version 1 (17-02-2022)

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Citer

Dorian Nezam, Raphaël Porcher, François Grolleau, Pauline Morel, Dimitri Titeca-Beauport, et al.. Kidney Histopathology Can Predict Kidney Function in ANCA-Associated Vasculitides with Acute Kidney Injury Treated with Plasma Exchanges. Journal of the American Society of Nephrology, 2022, pp.ASN.2021060771. ⟨10.1681/ASN.2021060771⟩. ⟨hal-03579125⟩
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