A model to predict cardiovascular events in patients with newly diagnosed Wegener's granulomatosis and microscopic polyangiitis

Suppiah, Ravi; Judge, Andrew; Batra, R N; Floßmann, Oliver; Harper, Lorraine; Höglund, Peter; Javaid, M K; Jayne, David; Mukhtyar, Chetan; Westman, Kerstin; Davis, John C.; Hoffman, Gary S.; McCune, W. Joseph; Merkel, Peter A.; Clair, E. William St.; Seo, Philip; Spiera, Robert; Stone, John H.; Luqmani, Raashid

doi:10.1002/acr.20433

Cited by 159 publications

(95 citation statements)

References 39 publications

(53 reference statements)

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“…After 12 months, the major cause of death was cardiovascular disease, presumably related to ESRD. Early cardiovascular events have been previously reported in association with ANCA vasculitis and are postulated to be related to active inflammation as well as underlying atherosclerosis (21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

“…The renal biopsy specimens of 153 patients were reviewed. The median number of glomeruli examined per biopsy specimen was 16 (IQR, [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. The pattern of glomerular injury according to the EUVAS schema was categorized as sclerotic in 32% of cases, focal in 6%, crescentic in 43%, and mixed class in 6%.…”

Section: Cohort Description and Outcomesmentioning

confidence: 99%

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Predictors of Treatment Outcomes in ANCA-Associated Vasculitis with Severe Kidney Failure

Lee

Gasim

Derebail³

et al. 2014

Clinical Journal of the American Society of Nephrology

126

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Background and objectives In ANCA-associated GN, severe renal dysfunction portends a poor prognosis for renal recovery and patient survival. This study evaluated the prognostic factors affecting renal and patient outcomes in patients presenting with severe kidney failure to guide immunosuppressive therapy.Design, setting, participants, & measurements This study retrospectively evaluated clinical and histopathologic characteristics of 155 patients who underwent biopsy between October 1985 and February 2011 (median eGFR at presentation, 7.1 ml/min per 1.73 m 2 ; 87% required hemodialysis), all treated with immunosuppressive medications. Three outcomes of interest were measured: patient survival, renal survival, and treatment response (defined as dialysis-free survival without active vasculitis by 4 months after biopsy). Competing risk, Cox, and logistic regression analyses were conducted for each outcome measure.Results Within 4 months after biopsy, treatment response was attained in 51% of patients, 35% remained on dialysis, and 14% died. In a competing risk analysis, estimated cumulative incidence rates of ESRD and diseaserelated mortality were 26% and 17% at 1 year and 32% and 28% at 5 years, respectively. Cyclophosphamide therapy and treatment response by 4 months were independently associated with patient and renal survival, adjusting for the percentage of normal glomeruli, histopathologic chronicity index score, and baseline clinical characteristics. Only 5% of patients still dialysis dependent at 4 months subsequently recovered renal function. Low chronicity index score (odds ratio [OR], 1.16; 95% confidence interval [95% CI], 1.04 to 1.30, per unit decrease) and baseline eGFR.10 ml/min per 1.73 m 2 (OR, 2.77; 95% CI, 1.09 to 7.01) were significantly associated with treatment response by 4 months. Among cyclophosphamide-treated patients, the likelihood of treatment response was .14% even with highest chronicity index score and eGFR,10 ml/min per 1.73 m 2 .Conclusions Although low baseline renal function and severe renal scarring are associated with lower treatment response rate, no "futility" threshold could be identified. Conversely, continued immunosuppressive therapy beyond 4 months is unlikely to benefit patients who remain dialysis dependent.Clin J Am Soc Nephrol 9: 905-913, 2014.

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Section: Discussionmentioning

confidence: 99%

Section: Cohort Description and Outcomesmentioning

confidence: 99%

Predictors of Treatment Outcomes in ANCA-Associated Vasculitis with Severe Kidney Failure

Lee

Gasim

Derebail³

et al. 2014

Clinical Journal of the American Society of Nephrology

126

View full text Add to dashboard Cite

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“…140 This study also showed that independent determinants of cardiovascular outcome were: older age (OR 1.45, 95% CI 1.11 to 1.90), diastolic hypertension (OR 1.97, 95% CI 0.98 to 3.95) and PR3-ANCA (OR 0.39, 95% CI 0.20 to 0.74). 140 Annual review of traditional Framingham risk factors is appropriate.…”

Section: Statement 13mentioning

confidence: 68%

Erratum: Eular/ERA-EDTA recommendations for the management of ANCA-associated vasculitis

2017

Ann Rheum Dis

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In this article, the 2009 European League Against Rheumatism (EULAR) recommendations for the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) have been updated. The 2009 recommendations were on the management of primary small and medium vessel vasculitis. The 2015 update has been developed by an international task force representing EULAR, the European Renal Association and the European Vasculitis Society (EUVAS). The recommendations are based upon evidence from systematic literature reviews, as well as expert opinion where appropriate. The evidence presented was discussed and summarised by the experts in the course of a consensus-finding and voting process. Levels of evidence and grades of recommendations were derived and levels of agreement (strengths of recommendations) determined. In addition to the voting by the task force members, the relevance of the recommendations was assessed by an online voting survey among members of EUVAS. Fifteen recommendations were developed, covering general aspects, such as attaining remission and the need for shared decision making between clinicians and patients. More specific items relate to starting immunosuppressive therapy in combination with glucocorticoids to induce remission, followed by a period of remission maintenance; for remission induction in lifethreatening or organ-threatening AAV, cyclophosphamide and rituximab are considered to have similar efficacy; plasma exchange which is recommended, where licensed, in the setting of rapidly progressive renal failure or severe diffuse pulmonary haemorrhage. These recommendations are intended for use by healthcare professionals, doctors in specialist training, medical students, pharmaceutical industries and drug regulatory organisations.

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“…К не-зависимым факторам риска ССЗ относят пожилой возраст, диастолическую гипертензию, специфичность АНЦА к ПР3 [34]. Рекомендация 14.…”

Section: рекомендация 13 рекомендована периодическая оцен-ка риска сunclassified

The 2016 European (Eular/Era-Edta) Recommendations for the Diagnosis and Management of Anca-Associated Systemic Vasculitis

Бекетова¹

2017

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A model to predict cardiovascular events in patients with newly diagnosed Wegener's granulomatosis and microscopic polyangiitis

Cited by 159 publications

References 39 publications

Predictors of Treatment Outcomes in ANCA-Associated Vasculitis with Severe Kidney Failure

Predictors of Treatment Outcomes in ANCA-Associated Vasculitis with Severe Kidney Failure

Erratum: Eular/ERA-EDTA recommendations for the management of ANCA-associated vasculitis

The 2016 European (Eular/Era-Edta) Recommendations for the Diagnosis and Management of Anca-Associated Systemic Vasculitis

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