Preferences Regarding Treatment with Plasma Exchange for ANCA-Associated Vasculitis: An International Patient Survey
Bibliographic record
Abstract
Background: Patient preferences regarding plasma exchange (PLEX) for ANCA-associated vasculitis (AAV) are uncertain. We sought to elicit patient preferences regarding the use of PLEX in AAV. Methods: An online survey was circulated via national vasculitis and kidney patient networks. Respondent characteristics were collected and information regarding PLEX in AAV was provided including its minimal effect on mortality. One year risks of end stage kidney disease (ESKD) and serious infections with and without PLEX in AAV were presented across 5 serum creatinine categories: 150, 250, 350, 450 and 600μmol/L. For each scenario, participants were asked: “If they were a patient with a new diagnosis or relapse of AAV, would they choose treatment with PLEX (yes or no) given its absolute risk reduction in ESKD, but absolute risk increase in serious infections?” Multilevel multivariable logistic regression was performed to identify independent predictors of choosing treatment with PLEX. Results: There were 549 responses. The mean age of respondents was 57.4 (SD 14.5) years, 72.3% were female, and respondents were from the United States (58.1%), United Kingdom (23.7%), Canada (14.0%), and other countries (4.2%). The majority had AAV (86.7%). 190/549 (34.6%) would always choose PLEX and 87/549 (15.8%) would always decline PLEX across the baseline risks of ESKD or serious infections presented. Independent predictors for choosing PLEX included age (OR 0.98, 95% CI 0.96-0.99 per 1 year increase), country (United Kingdom OR 2.73, 95% CI 1.20-6.21), diagnosis (individuals with vasculitis other than AAV were more likely), previous dialysis (OR 3.34, 95% CI 1.37-8.16), previous PLEX (OR 5.13, 95% CI 2.50-10.49), and increased baseline risk of ESKD (Cr 350 and 450μmol/L only). Conclusions: One third of participants would always choose treatment with PLEX across the 5 scenarios presented. The decision to choose PLEX is influenced by age, country, previous dialysis, and the baseline risk of ESKD and serious infections. Patient values and preferences are needed to inform shared decision-making regarding PLEX in AAV.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
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; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
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".