Renal Involvement in Granulomatosis With Polyangiitis Increases Economic Health Care Burden: Insights From the National Inpatient Sample Database

Abstract

Background This study aims to compare outcomes of hospitalizations of granulomatosis with polyangiitis (GPA) with and without renal involvement. The primary outcome was inpatient mortality, whereas secondary outcomes were hospital length of stay (LOS) and total hospital charge. Methods Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 databases. The NIS was searched for GPA hospitalizations with and without renal involvement as the principal or secondary diagnosis using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10) codes. GPA hospitalizations for adult patients from the above groups were identified. Multivariate logistic and linear regression analyses were used to adjust for possible confounders for the primary and secondary outcomes, respectively. Results There were more than 71 million discharges included in the combined 2016 and 2017 NIS database, of which 23,670 were for adult patients who had either a principal or secondary ICD-10 code for GPA, and 8,265 (34.92%) of these GPA hospitalizations had renal involvement. Hospitalizations for GPA with renal involvement had similar inpatient mortality (3.8% vs. 3.7%; adjusted OR: 1.14; 95% CI: 0.84-1.56; p=0.406) compared to those without renal involvement. GPA with renal involvement hospitalizations had an increase in adjusted mean LOS of 1.36 days (95% CI: 0.82-1.91; p=0.0001) compared to those without renal involvement. GPA with renal involvement hospitalizations had an increase in adjusted total hospital charges of $18,723 (95% CI: 9,595-27,852; p=0.0001) compared to those without renal involvement. Conclusions GPA with renal involvement hospitalizations had similar inpatient mortality compared to those without renal involvement. However, LOS and total hospital charges were greater in those with renal involvement.

Intestinal perforation as a first presentation of granulomatosis with polyangiitis: unusual case report

“…Renal involvement is presented in only 10%–20% of cases, and in 80% of patients within two years of disease onset, which is incompatible with our case. RPGN is characterized clinically by a rapid decrease in the glomerular filtration rate, and histologically pauci-immune necrotizing and extensive glomerular crescent formation [ 7 , 8 ], as in our case.…”

ANCA-associated vasculitis with active kidney involvement in the United States: 2016–2020

“…However, this study, along with other past studies on AAV, included a mixed cohort of those presenting to the hospital with active kidney injury or admitted for other reasons concurrently with a remote diagnosis and little or no active kidney involvement. For example, when Idolor et al [ 20 ] claimed that lengths of stay and inpatient costs were higher in GPA with renal involvement compared to those without, “maintenance hemodialysis” in “GPA without renal involvement” was reported as 12.33%.…”

Granulomatosis With Polyangiitis Presenting as Chest Pain: A Case Report

“…In fact, 80% of GPA patients develop renal involvement within two years of the disease onset. The most common renal presentation is rapidly progressive glomerulonephritis (RPGN), which can lead to renal failure [ 6 ]. As with our patient, the RPGN is pauci-immune, indicating it is not associated with immune-complex deposition under IF.…”