Evidence map›Paper›PMID 38270601›Full record

ArticlePediatric nephrology (Berlin, Germany)2024

Abbreviated protocol of plasma exchanges for patients with anti-factor H associated hemolytic uremic syndrome.

Sharan Thangaraju, Priyanka Khandelwal, Kirtisudha Mishra, Manish Kumar, Mamta Puraswani, Rahul Saini, Pankaj Hari, Poonam Coshic, Aditi Sinha, Arvind Bagga

Abstract read
PubMed Publisher
In one paragraph

Article in Pediatric nephrology (Berlin, Germany), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Review
  3. Review
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Sharan ThangarajuDivision of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
Priyanka KhandelwalDivision of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
Kirtisudha MishraDepartment of Pediatrics, Chacha Nehru Bal Chikitsalaya, Delhi, India.
Manish KumarDepartment of Pediatrics, Chacha Nehru Bal Chikitsalaya, Delhi, India.
Mamta PuraswaniDivision of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
Rahul SainiDivision of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
Pankaj HariDivision of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
Poonam CoshicDepartment of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India.
Aditi SinhaDivision of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
Arvind BaggaDivision of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India. arvindbagga@hotmail.com.ORCID 0000-0002-7832-684X

Funding

Department of Science and Technology, Government of India EMR12016/002781Indian Council of Medical Research 5/4/7-18/Nephro/2020-NCDIIIndian Council of Medical Research 5/7/1090/2013-RHN
6 · The paper itself

Abstract

backgroundPlasma exchanges (PEX) and immunosuppression are the cornerstone of management of anti-factor H (FH) antibody-associated atypical hemolytic uremic syndrome (aHUS), particularly if access to eculizumab is limited. The duration of therapy with PEX for anti-FH aHUS is empirical.

methodsWe compared the efficacy of abbreviated PEX protocol (10-12 sessions) in a prospective cohort of patients diagnosed with anti-FH aHUS (2020-2022), to standard PEX protocol (20-22 sessions) in a historical cohort (2016-2019; n = 65). Efficacy was defined as 70% decline in anti-FH titers or fall to ≤ 1300 AU/ml at 4 weeks. Patients in both cohorts received similar immunosuppression with oral prednisolone, IV cyclophosphamide (5 doses) and mycophenolate mofetil. Outcomes included efficacy, rates of hematological remission and adverse kidney outcomes at 1, 3 and 6 months.

resultsOf 23 patients, 8.2 ± 2.1 years old enrolled prospectively, two were excluded for significant protocol deviation. PEX was abbreviated in 18/21 (86%) patients to 11.5 ± 3.3 sessions. Abbreviation failed for lack of hematological remission by day 14 (n = 2) and persistent neurological manifestations (n = 1). All patients in whom PEX was abbreviated achieved > 70% reduction in anti-FH titers at day 28. The percentage fall in anti-FH titers was similar for the abbreviated vs. standard PEX protocols at 1, 3 and 6 months. At last follow-up, at median 50 months and 25 months for standard and abbreviated cohorts, the estimated GFR was similar at 104.8 ± 29.1 vs. 93.7 ± 53.4, respectively (P = 0.42).

conclusionAbbreviation of the duration of PEX is feasible and efficacious in reducing anti-FH titers. Short-term outcomes were comparable in patients managed by abbreviated and standard PEX protocols.

Indexed as

Atypical Hemolytic Uremic SyndromeComplement Factor HPlasma ExchangeAntibodies, Monoclonal, HumanizedAutoantibodiesChildChild, PreschoolHumansImmunosuppressive AgentsMaleMycophenolic AcidProspective StudiesTreatment OutcomeAntibodies, Monoclonal, HumanizedAutoantibodiesComplement Factor HeculizumabImmunosuppressive AgentsMycophenolic AcidHemolytic uremic syndromePlasma exchangeThrombotic microangiopathy

Identifiers

PMID38270601

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.