Plasma Exchange for ANCA-Associated Vasculitis: An International Survey of Patient Preferences

David Collister; Mark Farrar; Lesha Farrar; Paul Brown; Michelle Booth; Tracy Firth; Alfred Mahr; Linan Zeng; Mark A Little; Reem A Mustafa; Lynn A Fussner; Alexa Meara; Gordon Guyatt; David Jayne; Peter A Merkel; Michael Walsh

doi:10.1016/j.xkme.2022.100595

Plasma Exchange for ANCA-Associated Vasculitis: An International Survey of Patient Preferences

Kidney Med. 2022 Dec 24;5(3):100595. doi: 10.1016/j.xkme.2022.100595. eCollection 2023 Mar.

Authors

David Collister^{1

2}, Mark Farrar³, Lesha Farrar³, Paul Brown⁴, Michelle Booth⁴, Tracy Firth³, Alfred Mahr⁵, Linan Zeng⁶, Mark A Little⁷, Reem A Mustafa⁸, Lynn A Fussner⁹, Alexa Meara⁹, Gordon Guyatt⁶, David Jayne¹⁰, Peter A Merkel^{11

12}, Michael Walsh^{2

6

13}

Affiliations

¹ Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
² Population Health Research Institute, Hamilton, Ontario, Canada.
³ Vasculitis UK.
⁴ Vasculitis Patient-Powered Research Network, Kansas City, MO.
⁵ Clinic for Rheumatology, Kantonnspital St Gallen, St Gallen, Switzerland.
⁶ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
⁷ Trinity Health Kidney Centre, Tallaght University Hospital, Dublin, Ireland.
⁸ Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Health System, Kansas City, KS.
⁹ Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH.
¹⁰ Department of Medicine, University of Cambridge, United Kingdom.
¹¹ Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA.
¹² Division of Clinical Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA.
¹³ Department of Medicine, Division of Nephrology, McMaster University, Hamilton, Ontario, Canada.

Abstract

Rationale & objective: We sought to elicit patient preferences regarding the use of plasma exchange in antineutrophil cytoplasmic antibody-associated vasculitis (AAV) and its tradeoffs of risk of kidney failure and risk of serious infection.

Study design: Patient survey.

Setting & participants: The online survey was circulated to adults with AAV via kidney and vasculitis networks in Canada, the United Kingdom, and the United States.

Outcomes: Respondents reviewed the estimated 1-year risks of kidney failure and serious infection in AAV with and without plasma exchange across 5 serum creatinine categories (150, 250, 350, 450, and 600 μmol/L). For each scenario, participants indicated whether or not they would choose plasma exchange.

Analytical approach: Responses were assessed with multilevel multivariable logistic regression models to identify predictors of respondent choice regarding treatment with plasma exchange.

Results: The 470 respondents from the 13 countries (United States 61.7%, United Kingdom 20.0%, Canada 13.8%, and other countries 4.5%) had a mean age of 58.6 (SD 14.3) years, 70.2% women. Respondents were more likely to choose plasma exchange in scenarios at high risk of kidney failure and serious infection (creatinine level of 350 or 450 μmol/L) compared with lower risk scenarios or the highest risk scenario. However, 145 (30.9%) chose plasma exchange across all scenarios, whereas 80 (17.0%) declined plasma exchange across all scenarios. Respondents from the United Kingdom (OR, 2.61; 95% CI, 1.09-6.22) who received previous dialysis (OR, 2.70; 95% CI, 1.12-6.52) or received previous plasma exchange (OR, 5.62; 95% CI, 2.72-11.61) were more likely to choose plasma exchange, whereas older respondents (OR, 0.98; 95% CI, 0.96-0.99 per 1 year increase) were less likely.

Limitations: Unclear generalizability to non-English-speaking, older, and less health literate adults, possible responder bias, survivor bias, lack of individualized risk assessments for kidney failure, and serious infection.

Conclusions: Patients with AAV do not express a consistent choice for plasma exchange, which highlights the need for shared decision making.

Keywords: ANCA-associated vasculitis; plasma exchange; survey.