The Outcomes of Patients with ESRD and ANCA-Associated Vasculitis in Australia and New Zealand

Tang, Wen; Bose, Bhadran; McDonald, S.; Hawley, Carmel M.; Badve, Sunil V.; Boudville, Neil; Brown, Fiona G.; Clayton, Philip; Campbell, Scott; Peh, Chen Au; Johnson, David W.

doi:10.2215/cjn.08770812

Cited by 44 publications

(48 citation statements)

References 21 publications

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“…Mortality comparisons accounting for case-mix differences were, again, not performed. With the exception of this subgroup analysis, most other studies examining mortality outcomes after ERSD development in GN were restricted to single GN subtypes (3,(15)(16)(17) or combined subtypes into a single GN category (18,19), precluding direct comparisons across GN subtypes.…”

Section: Discussionmentioning

confidence: 99%

Patient Characteristics and Outcomes by GN Subtype in ESRD

O’Shaughnessy

Montez‐Rath

Lafayette

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Outcomes-based research rarely focuses on patients with ESRD caused by GN. The hypotheses were that the GN subtype would clinically discriminate patient groups and independently associate with survival after ESRD therapy initiation.Design, setting, participants, & measurements Data were extracted from the US Renal Data System for adult patients with incident (1996-2011) ESRD attributed to six GN subtypes: FSGS, IgA nephropathy (IgAN), membranous nephropathy, membranoproliferative glomeruonephritis, lupus nephritis (LN), and vasculitis. ESRD attributed to diabetes and autosomal dominant polycystic kidney disease served as non-GN comparators. Unadjusted and adjusted mortality hazard ratios (aHRs) with 95% confidence intervals (95% CIs) were estimated using Cox regression (reference, IgAN). Models sequentially adjusted for sociodemographic (model 2), comorbidity/laboratory (model 3), and ESRD treatment modality (model 4) variables.Results Among 84,301 patients with ESRD attributed to GN, the median age ranged from 39 (LN) to 66 (vasculitis) years, male sex ranged from 18% (LN) to 68% (IgAN), and black race ranged from 7% (IgAN) to 49% (LN). Patients with IgAN had the fewest comorbidities and lowest use of hemodialysis (70.1%). After a median followup of 2.5 (interquartile range, 1.0-4.9) years, crude mortality was lowest in IgAN (3.7 deaths/100 person years). Compared to IgAN, adjusted mortality was highest in LN (model 4 aHR=1.75; 95% CI, 1.68 to 1.83) and in diabetes (aHR=1.73; 95% CI, 1.67 to 1.79), and was also higher in all other GN subtypes (membranous nephropathy: aHR=1.23; 95% CI, 1.17 to 1.29; FSGS: aHR=1.37; 95% CI, 1.32 to 1.42; membranoproliferative GN: aHR=1.38; 95% CI, 1.31 to 1.45; vasculitis: aHR=1.51; 95% CI, 1.45 to 1.58) and in autosomal dominant polycystic kidney disease (aHR=1.22; 95% CI, 1.18 to 1.27).Conclusions This study exposes substantial heterogeneity across GN subtypes at ESRD therapy initiation and identifies independent associations between GN subtype and post-ESRD mortality. These survival discrepancies warrant further study, and the utility of current research practice to group GN subtypes together when evaluating ESRD outcomes should be questioned.

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Section: Discussionmentioning

confidence: 99%

Patient Characteristics and Outcomes by GN Subtype in ESRD

O’Shaughnessy

Montez‐Rath

Lafayette

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…We found 2 studies that directly compared graft and patient outcomes with GPA and MPA. 7,9 The study by Little and associates 7 did not show any difference between GPA and MPA.…”

Section: Pooled Analysesmentioning

confidence: 91%

“…Six studies with a total of 736 kidney recipients reported 10-year survival data. 7,9,18,19,21,24 In these studies, patient survival rates ranged from 64% to 80 % and graft survival rates ranged from 59% to 84%. Four studies 4,17,22,23 and our current study with a total of 103 recipients reported 5-year patient survival of 77% to 100% and graft survival of 60% to 100%.…”

Section: Pooled Analysesmentioning

confidence: 98%

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Buttigieg

Henderson

Kidder

2017

Exp Clin Transplant

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Objectives: Kidney transplant outcomes in patients with antineutrophil cytoplasmic antibody-associated vasculitis are comparable with outcomes in patients transplanted for other causes. Here, we report our single center experience of kidney transplant in patients with this condition and a pooled analysis of published studies. Materials and Methods: This retrospective study included all patients with end-stage kidney disease secondary to antineutrophil cytoplasmic antibodyassociated vasculitis who received a kidney transplant between 1987 and 2013 in the East of Scotland. We examined patient and graft survival and disease recurrence after transplant. We also performed a pooled analysis of published literature. Results: We identified 24 patients who received a total of 31 kidney allografts. Median age at first transplant was 45.5 years (range, 18-68 y), and median follow-up after transplant was 60 months (range, 0.5-226 mo). All patients were positive for antineutrophil cytoplasmic antibody (71% by proteinase 3 and 29% by myeloperoxidase) at diagnosis. Patient survival at 1 and 5 years was 92% and 88%, with corresponding death-censored allograft survival of 93% and 71%. Overall patient and allograft relapse rates were 0.022 and 0.016 relapse/patient-years. The pooled analysis comprised 20 studies (1169 patients). Patient/graft survival ranged from 64% to 80%/77% to 100% at 5 years and from 60% to 100%/59% to 84% at 10 years. Relapse rate was significantly higher in patients with positive antineutrophil cytoplasmic antibody at transplant (14% vs 5%; P = .042). Conclusions: Our experience shows that kidney transplant remains a safe option for patients with endstage kidney disease secondary to antineutrophil cytoplasmic antibody-associated vasculitis. Disease relapse posttransplant is uncommon and associated with pretransplant relapse. Pooled analyses suggest that relapse rate is higher in patients with positive antineutrophil cytoplasmic antibody at transplant. Multicenter registry data are needed to define renal outcome predictors in antineutrophil cytoplasmic antibody-associated vasculitis.

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“…AAV patients with ESRD on dialysis have a worse prognosis compared to those without dialysis independent renal function [36]. However, the overall mortality of AAV patients on dialysis is similar to those non-diabetic patients on dialysis [37][38][39]. Renal transplantation (RTx) is the first choice of treatment in these patients.…”

Section: Renal Transplantationmentioning

confidence: 99%

Microscopic Polyangiitis: from Pathogenesis to Treatment

Dousdampanis¹,

Assimakopoulos²,

Trigka³

2017

UNOAJ

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Microscopic Polyangiitis (MPA) is a systemic pauci-immune necrotizing vasculitis of small-calibre vessels characterized by the absence of granulomas. MPA is an autoimmune disease but its aetiology remains obscure. MPA is associated with presence of antineutrophil cytoplasmatic autoantibodies (ANCAs) but not all patients with MPA have ANCAs. There is strong evidence that not all ANCAs are pathogenetic. It seems that specific epitopes determine ANCAs pathogenicity. Given that MPA is a systemic vasculitis, multiple organs could be affected resulting in a wide spectrum of signs and symptoms. The kidneys and lungs are the most typical organs involved in MPA. Notably, MPA is the major cause of pulmo-renal syndrome. MPA has a poor prognosis if not treated but the use of aggressive immunosuppressive treatment has improved the prognosis and the patient's survival. Rituximab could be considered as an alternative treatment for severe disease, for patients who do not respond adequately to the immunosuppressive treatment and for patients with relapses. However, the long-term safety of Rituximab in MPA is unknown and it should be elucidated by further studies. Interestingly, kidney transplantation is safe and effective and it has a good prognosis in MPA patients with ESRD.

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The Outcomes of Patients with ESRD and ANCA-Associated Vasculitis in Australia and New Zealand

Cited by 44 publications

References 21 publications

Patient Characteristics and Outcomes by GN Subtype in ESRD

Patient Characteristics and Outcomes by GN Subtype in ESRD

Untitled

Microscopic Polyangiitis: from Pathogenesis to Treatment

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