Table 2

Interventions in the plasma exchange studies

Study ID

Treatment

Control

Study outcomes


Cole

1992

PE: at least 10 PE treatments

within 16 days of trial entry.

One plasma volume with complete

replacement using 5% albumin +

crystalloid.

Immunosuppression: as for

control group

Immunosuppression

IV MP 10 mg/kg/d for 3 days followed

by prednisone 1.4 mg/kg/d for next 4 days

and then tapered to 1 mg/kg/d over 2 weeks

0.35 mg/kg/d at 1 month and 0.25 mg/kg/d

at 2 months.

AZA 1.5-3.0 mg/kg/d with dose adjustment

as necessary to ensure neutrophil count of

2.0 × 109/L or greater

1. renal pathology

2. Patients on dialysis at

randomisation - dialysis at 1,

3, 6, 12 months

3. Renal function in patients

not on dialysis - 1, 3, 6, 12 months

4. Change in SCr

5. Adverse events (serious infections,

gastrointestinal bleeding)

6. Mortality

Jayne

2007

Seven PE of 60 ml/kg in first 2

weeks after diagnosis

Immunosuppression as for control

group

Three pulses of 1000 mg IV MP

followed by oral CPA and a

tapering regimen of prednisolone.

1. Mortality

2. Dialysis

3. Side effects

4. Serum creatinine

at 12 months

Glockner

1988

Nine 50 ml/kg PE over 4 weeks

replaced with 3-5% Albumin solution.

Immunosuppression as for control group

CPA 3 mg/kg/d plus AZA 1 mg/kg/d for

1 week then AZA 2 mg/kg/d. 6-methyl

prednisolone 1.5 mg/kg/d for 14 days

reducing in 4 mg/d steps to

maintenance 8 mg/d.

1. Mortality at 6 months

2. Dialysis at 6 months

3. SCr at 4 weeks, 8 weeks

and 6 months

4. Adverse events including

serious infections, GI

haemorrhage and anaphylaxis

Mauri

1985

PE alternate days for 6 treatments.

Exchanges of at least 3.5 L replaced

with 3.5% Albumin and 2 units FFP.

Immunosuppression as for control group

CPA 2 mg/kg/d and Prednisolone

1 mg/kg/d. Doses reduced to half

after 8 weeks. Prednisolone dose

tapered progressively. CPA dose

reduced to 0.5 mg/kg/d after 2

months then stopped after month 4.

1. Mortality

2. Dialysis post

treatment, at 3

months and 12 months

after treatment

3. SCr after treatment

and 6 months later

Pusey

1991

PE: 5 × 4 L exchanges of 5%

albumin (plasma protein fraction)

within first week. Two units

of fresh frozen plasma were given

at end of exchange. Total number

of exchanges determined by clinical

response.

Immunosuppression as for control group

Induction therapy: 8 weeks of:

1. 60 mg/d prednisolone, reduce to 30 mg/d

at week 3, taper slowly.

2. CPA 3 mg/kg/d or 2 mg/kg/d for those

over 55 years

3. AZA 1 mg/kg/d or no AZA for those

over 55 years

Maintenance therapy: CPA stopped after 8

weeks in those with remission and AZA

increased to 2-3 mg/kg/d, together with

tapering doses of prednisolone"

1. Improvement (fall in SCr > 25%

or rise in CrCl > 25%; recovery

of renal function in those initially

on dialysis)

2. SCr

3. Dialysis

4. Death

5. Adverse event

Rifle

1980

PE. Five sessions during 5 successive

days, then 3 sessions/week until

15 days after SCr reached a plateau.

Treatment could not exceed 2 months.

1.5 plasma volumes exchanged.

Immunosuppression as for control

group

IV pulse MP (15 mg/kg/d for 3 days,

tapered to 15 mg/d for 3 days, then 3 new

pulses, then 15 mg/d for 7 weeks.

CPA 2-3 mg/kg/d for 2 months.

Calcium heparinate 9 days after renal

biopsy for the duration of the study.

1. Dialysis 2, 6 12,

24 months

2. CrCl at 2, 6 and 12 months.

3. Recovery (off dialysis)

according to initial SCr level

4. Recovery (off dialysis) according

to initial % of crescents

5. Death

6. Circulating immune complexes

7. Pathology changes

8. Adverse events (septicaemia)


Walters et al. BMC Nephrology 2010 11:12   doi:10.1186/1471-2369-11-12

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