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Plasma Exchange in ANCA-Associated Vasculitis With Kidney Involvement: Differential Outcomes by Kidney Function in a

Clara Escorcia-García1, Mauricio Restrepo-Escobar2, Lina Aguirre3

  • 1Department of Internal Medicine, Division of Nephrology, University of Antioquia, Medellín, Colombia.

Journal of Clinical Apheresis
|February 23, 2026
PubMed

Insights

Plasma exchange (PLEX) did not reduce mortality or end-stage kidney disease (ESKD) in ANCA-associated vasculitis (AAV) overall. However, PLEX showed benefit for patients with severe kidney dysfunction (creatinine > 5.7 mg/dL).

Area of Science:

  • Nephrology
  • Rheumatology
  • Immunology

Background:

  • ANCA-associated vasculitis (AAV) commonly affects the kidneys, potentially leading to end-stage kidney disease (ESKD).
  • The efficacy of plasma exchange (PLEX) in managing kidney involvement in AAV is not well-established.

Purpose of the Study:

  • To evaluate the effectiveness of plasma exchange (PLEX) in patients with ANCA-associated vasculitis (AAV) and kidney dysfunction.
  • To determine if PLEX impacts the composite outcome of all-cause mortality or ESKD in AAV patients with impaired kidney function.

Main Methods:

  • Retrospective cohort study involving 163 patients with AAV and serum creatinine ≥ 1.5 mg/dL.
  • Comparison of outcomes between patients who received PLEX and those who did not.
  • Analysis of primary outcome (all-cause mortality or ESKD) and secondary outcomes, including in-hospital infections.

Main Results:

  • Overall, PLEX was not associated with a significant reduction in the composite outcome of mortality or ESKD (aHR 1.04).
  • In patients with baseline creatinine > 5.7 mg/dL, PLEX was linked to a lower risk of ESKD (aHR 0.38) and a borderline reduction in the composite outcome (HR 0.45, p=0.05).
  • Patients receiving PLEX experienced a significantly higher rate of in-hospital infections (aRR 4.66, p=0.001).

Conclusions:

  • Plasma exchange may not offer overall benefit for kidney outcomes in ANCA-associated vasculitis patients with moderate kidney dysfunction.
  • PLEX could be beneficial for selected AAV patients with severe kidney impairment, warranting further investigation.
  • Increased risk of in-hospital infections is a significant consideration when using PLEX in AAV patients.

Keywords:
ANCA‐associated vasculitisend‐stage kidney diseaseglomerulonephritisin‐hospital infectionsmortalityplasma exchangeserum creatinine

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