Abstract: SA-PO0845
Centrifuge vs. Filter Separation: Which Is the Best Variant for Plasma Exchange in ANCA-Associated Vasculitis? A Post Hoc Analysis of the PEXIVAS Trial
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
- Sanchez Alamo, Beatriz, Hospital Universitario Alcorcon, Madrid, Spain
- Iordanou, Maria, Lunds Universitet, Lund, Skåne County, Sweden
- Jayne, David R.W., Cambridge University Medicine, Cambridge, United Kingdom
- Merkel, Peter A., Penn Rheumatology Perelman, Philadelphia, Pennsylvania, United States
- Walsh, Michael, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Westman, Kerstin W., Lunds Universitet, Lund, Skåne County, Sweden
Group or Team Name
- EUVAS
Background
Therapeutic plasma exchange (PLEX) is used in selected ANCA-associated vasculitis (AAV) patients, but the impact of plasma separation modality on outcomes is unclear. Centrifugation and membrane filtration differ in efficiency, anticoagulation, and procedural features, yet comparative data are scarce.We evaluated the effect of PLEX modality on renal recovery, safety, progression to ESKD, and survival in PEXIVAS participants.
Methods
We performed a post hoc analysis of PEXIVAS participants receiving ≥7 PLEX sessions,grouped by modality:centrifugation(n=204) or filtration(n=127).Primary outcomes included assesment of longitudinal kidney function during follow-up(52 weeks);secondary outcomes were serious adverse events and mortality.
Results
Baseline demographic and immunologic characteristics were similar between groups.Filtration patients had higher baseline serum creatinine (339 vs 316 µmol/L,p=0.01), while pulmonary hemorrhage was more frequent with centrifugation.The centrifugation group received higher cumulative methylprednisolone and CYC doses.Both modalities achieved substantial renal recovery at w52,with reduced CKD G5 and shift toward G3–G4.Baseline G5 CKD was present in 57.4%(centrifugation) and 64.6%(filtration).At w52,G3 predominated in centrifugation (44.6%),while filtration patients were distributed between G3(37.5%) and G4(38.4%).No differences were observed in progression to ESKD at w52(30 vs 24 patients,p=0.09)or in death/ESKD(57 vs 33 patients,p=0.8).SAE incidence was similar between modalities(IRR:1.13;95%CI:0.95–1.36)during the first year.Infections were the most frequent complication, with no differences in incidence or time to first infection.
Conclusion
In this post hoc PEXIVAS analysis,centrifugation and filtration PLEX modalities showed similar outcomes in AAV patients with GFR<50 ml/min or pulmonary hemorrhage.PLEX modality selection may therefore rely on local expertise and availability.
Acknowledgment
Pexivas investigators