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

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.

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.

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.

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.

• Authors: Anoek A E de Joode, Jan Stephan F Sanders, Coen A Stegeman
• Journal: Clinical journal of the American Society of Nephrology : CJASN (Clin J Am Soc Nephrol) Vol. 8 Issue 10 Pg. 1709-17 (Oct 2013) ISSN: 1555-905X [Electronic] United States
• PMID: 23846462 (Publication Type: Journal Article)

Chemical References

• Peroxidase
• Myeloblastin

Topics

• Adult
• Aged
• Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis (complications, enzymology, mortality)
• Female
• Glomerular Filtration Rate
• Humans
• Kidney Failure, Chronic (etiology)
• Male
• Middle Aged
• Myeloblastin (analysis)
• Peroxidase (analysis)
• Renal Replacement Therapy