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Renal survival in proteinase 3 and myeloperoxidase ANCA-associated systemic vasculitis.

Renal survival in proteinase 3 and myeloperoxidase ANCA-associated systemic vasculitis.

Authors :
de Joode AA
Sanders JS
Stegeman CA
Source :
Clinical journal of the American Society of Nephrology : CJASN [Clin J Am Soc Nephrol] 2013 Oct; Vol. 8 (10), pp. 1709-17. Date of Electronic Publication: 2013 Jul 11.
Publication Year :
2013

Abstract

Background and Objectives: This study evaluated predictors for patient and renal survival in patients with ANCA-associated vasculitis (AAV) with and without renal involvement.<br />Design, Setting, Participants, & Measurements: There were 273 consecutive AAV patients from January 1990 until December 2007 who were followed until death, loss to follow-up, or December 2010. Based on organ involvement, patients were divided into renal (n=212) and nonrenal groups (n=61). The primary end point was ESRD requiring renal replacement therapy (RRT) or renal transplantation or death.<br />Results: Patient survival was significantly better in the nonrenal group compared with the renal group (hazard ratio, 0.55; 95% confidence interval, 0.33 to 0.92; P=0.02). In the renal group, renal survival was significantly worse in MPO-ANCA-positive patients (n=65) compared with PR3-ANCA-positive patients (n=138) (hazard ratio, 2.1; 95% confidence interval, 1.11 to 3.8; P=0.01). Of 48 patients who needed RRT at diagnosis, 11 patients (23%) died within 6 months and 14 patients (29%) did not regain renal function. Of all 23 patients who regained renal function after RRT, 7 patients (30%) were temporarily dialysis independent and needed dialysis later (range, 13-63 months). Five patients had a renal relapse in the 6 months before restart of RRT. Of all 203 PR3-ANCA-positive and MPO-ANCA-positive patients with renal involvement, 12 patients (6%) developed ESRD during follow-up. These patients were classified as CKD stage 4 or 5 after initial treatment and eight patients had a renal relapse before becoming dialysis dependent.<br />Conclusions: AAV patients with renal involvement who needed RRT had the worst survival probability. In multivariate analysis, the only major determinants for long-term renal survival were renal function at 6 months and renal relapses.

Details

Language :
English
ISSN :
1555-905X
Volume :
8
Issue :
10
Database :
MEDLINE
Journal :
Clinical journal of the American Society of Nephrology : CJASN
Publication Type :
Academic Journal
Accession number :
23846462
Full Text :
https://doi.org/10.2215/CJN.01020113