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Abstract: PO1626

Preferences Regarding Treatment with Plasma Exchange for ANCA-Associated Vasculitis: An International Patient Survey

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Collister, David Thomas, University of Manitoba, Winnipeg, Manitoba, Canada
  • Mahr, Alfred, Kantonsspital Sankt Gallen, Sankt Gallen, SG, Switzerland
  • Little, Mark Alan, Tallaght University Hospital, Dublin, Dublin, Ireland
  • Mustafa, Reem, University of Kansas Medical Center, Kansas City, Kansas, United States
  • Fussner, Lynn A., The Ohio State University, Columbus, Ohio, United States
  • Meara, Alexa Simon, The Ohio State University, Columbus, Ohio, United States
  • Jayne, David R.W., University of Cambridge, Cambridge, Cambridgeshire, United Kingdom
  • Merkel, Peter A., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Walsh, Michael, McMaster University, Hamilton, Ontario, Canada
Background

Patient preferences regarding plasma exchange (PLEX) for ANCA-associated vasculitis (AAV) are uncertain. We sought to elicit patient preferences regarding the use of PLEX in AAV.

Methods

An online survey was circulated via national vasculitis and kidney patient networks. Respondent characteristics were collected and information regarding PLEX in AAV was provided including its minimal effect on mortality. One year risks of end stage kidney disease (ESKD) and serious infections with and without PLEX in AAV were presented across 5 serum creatinine categories: 150, 250, 350, 450 and 600µmol/L. For each scenario, participants were asked: “If they were a patient with a new diagnosis or relapse of AAV, would they choose treatment with PLEX (yes or no) given its absolute risk reduction in ESKD, but absolute risk increase in serious infections?” Multilevel multivariable logistic regression was performed to identify independent predictors of choosing treatment with PLEX.

Results

There were 549 responses. The mean age of respondents was 57.4 (SD 14.5) years, 72.3% were female, and respondents were from the United States (58.1%), United Kingdom (23.7%), Canada (14.0%), and other countries (4.2%). The majority had AAV (86.7%). 190/549 (34.6%) would always choose PLEX and 87/549 (15.8%) would always decline PLEX across the baseline risks of ESKD or serious infections presented. Independent predictors for choosing PLEX included age (OR 0.98, 95% CI 0.96-0.99 per 1 year increase), country (United Kingdom OR 2.73, 95% CI 1.20-6.21), diagnosis (individuals with vasculitis other than AAV were more likely), previous dialysis (OR 3.34, 95% CI 1.37-8.16), previous PLEX (OR 5.13, 95% CI 2.50-10.49), and increased baseline risk of ESKD (Cr 350 and 450µmol/L only).

Conclusion

One third of participants would always choose treatment with PLEX across the 5 scenarios presented. The decision to choose PLEX is influenced by age, country, previous dialysis, and the baseline risk of ESKD and serious infections. Patient values and preferences are needed to inform shared decision-making regarding PLEX in AAV.