Plasma Exchange in Patients With ANCA-Associated Vasculitis: A #NephJC Editorial on a comPLEX Question
Bibliographic record
Abstract
2] Its role was further cemented in 2007 when Jayne et al 4 recruited 137 patients with severe AAV (serum creatinine >500 mol/L [5.7 mg/dL]) and demonstrated higher rates of independence from dialysis at 3 months for those who received PLEX compared to those who received induction with intravenous methylprednisolone (MEPEX). However, long-term follow-up at 4 years did not demonstrate benefit for either mortality or kidney survival. hirteen years later, the PEXIVAS (Plasma exchange and glucocorticoid dosing in the treatment of antineutrophil cytoplasm antibody-associated vasculitis) trial challenged the role of routine PLEX use in AAV with kidney or pulmonary involvement. The largest randomized controlled trial of AAV to date, PEXIVAS enrolled an impressive 704 patients with AAV and estimated glomerular filtration rate <50 mL/min/1.73 m 2 (including those needing dialysis) or pulmonary alveolar hemorrhage (PAH) to PLEX vs No-PLEX. There was no benefit of PLEX on the primary composite outcome of death or kidney failure (kidney failure hazard ratio, 0.86; 95% CI, 0.65-1.13) after a median follow-up of 2.9 years. he risks associated with PLEX now needed to be balanced against a seemingly diminishing benefit; it is pertinent to note the different inclusion criteria for renal function in the 2 prominent trials. The stage was set for the PEXIVAS authors to undertake an updated meta-analysis to see what the entirety of the evidence tells us.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.004 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".