372. Preferences regarding treatment with plasma exchange for ANCA-associated vasculitis: An extended international patient survey

Objectives: To elicit patient preferences regarding the use of plasma exchange (PLEX) in ANCA-associated vasculitis (AAV) and its tradeoffs of end stage kidney disease (ESKD) and serious infection.

Methods: Respondents reviewed the estimated one-year risks of ESKD and serious infection in AAV with and without PLEX across 5 serum creatinine categories. For each scenario, participants indicated whether or not they would choose PLEX. Responses were assessed with multilevel multivariable logistic regression models to identify predictors of respondent choice regarding treatment with PLEX.

Results: The 470 respondents from the 13 countries (United States 61.7%, United Kingdom 20.0%, Canada 13.8%, other countries 4.5%) had a mean age of 58.6 (SD 14.3) years, 70.2% female. Respondents were more likely to choose PLEX in scenarios at high risk of ESKD and serious infection (creatinine 350 or 450 µmol/L) compared to lower risk scenarios or the highest risk scenario. However, 145 (30.9%) chose PLEX across all scenarios while 80 (17.0%) declined PLEX 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 PLEX (OR 5.62, 95% CI 2.72-11.61) were more likely to choose PLEX while older respondents (OR 0.98, 95% CI 0.96-0.99 per 1 year increase) were less likely.

Conclusion: Patients with AAV do not express a consistent choice for PLEX based on the benefits and risks it carries for the outcomes of ESKD and serious infection. This inconsistency highlights the need for shared decision-making when considering PLEX in AAV.

Disclosures: None relevant to this work. Preliminary data presented here: https://www.asn-online.org/education/kidneyweek/2021/program-abstract.aspx?controlId=3611478