Abstract: SA-PO0863
Therapeutic Plasma Exchange Use After PEXIVAS in Hospitalized Adults with ANCA-Associated Vasculitis
Session Information
- Glomerular Diseases: Management, Evolving Strategies, and Practice-Changing Advances
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Zheng, Jacob Sun, Skyline High School, Ann Arbor, Michigan, United States
- Zheng, Lucy, Mount Sinai Morningside Hospital, New York, New York, United States
- Tan, Wenchy, Mount Sinai Morningside Hospital, New York, New York, United States
- Deb, Mrittika, Mount Sinai Morningside Hospital, New York, New York, United States
- Tan, Samuel, Icahn School of Medicine at Mount Sinai Department of Medicine, New York, New York, United States
- Lee, Maximillian, UPMC Harrisburg, Harrisburg, Pennsylvania, United States
Background
ANCA-associated vasculitis (AAV) causes life-threatening glomerulonephritis. Therapeutic plasma exchange (TPE) was widely used as adjunctive immunotherapy during severe flares. The PEXIVAS trial (February 2020) demonstrated TPE did not reduce death or end-stage kidney disease. Whether this landmark trial changed national inpatient practice is unknown.
Methods
Repeated cross-sectional study of adult AAV hospitalizations in the National Inpatient Sample, 2018–2022. Survey-weighted multivariable models compared pre-PEXIVAS (2018–2019) vs. post-PEXIVAS (2020–2022) periods, adjusting for age, sex, payer, income quartile, hospital teaching status, elective admission, and calendar year. Outcomes were therapeutic plasma exchange (TPE), kidney replacement therapy (KRT), and in-hospital mortality.
Results
We identified 7,847 hospitalizations (~39,235 weighted). Post-PEXIVAS hospitalizations had lower odds of TPE (aOR 0.64, 95% CI 0.40–1.01), with significant declines in GPA (aOR 0.46) and patients under 65 years (aOR 0.47). KRT also declined (aOR 0.80, 95% CI 0.65–0.97). No significant interaction was found by payer type (p=0.879) or hospital teaching status (p=0.293). In-hospital mortality was higher post-period (aOR 2.02, 95% CI 1.07–3.83).
Conclusion
PEXIVAS Trial was followed by a national decline in inpatient TPE use in AAV, most pronounced in GPA and in patients under 65 years. Practice shift was uniformly adopted across payer groups and hospital types, suggesting equitable translation of trial evidence. The reduction in TPE use was accompanied by a concurrent decline in KRT utilization, providing real-world reassurance that abandoning TPE did not worsen acute kidney outcomes during hospitalization. Elevated post-period mortality is more likely explained by COVID-19 deaths among immunosuppressed patients than by PEXIVAS-associated management changes. These findings confirm that a single landmark trial produced a rapid, broadly adopted, and apparently safe practice change in a rare disease.
| Outcome | Pre-PEXIVAS rate | Post-PEXIVAS rate | Adjusted OR (95% CI) | p-value |
| TPE utilization | 2.7% (2018-2019) | 2.2% (2020-2022) | 0.64 (0.40-1.01) | 0.055 |
| KRT requirement | ~21% | ~17% | 0.80 (0.65-0.97) | 0.022 |
| In-hospital mortality | ~1.3% | ~1.8% | 2.02 (1.07-3.83) | 0.031 |
Table 1. Primary outcomes for post-PEXIVAS versus pre-PEXIVAS hospitalizations.