Mortality Higher in ANCA-Associated Vasculitis with End-Stage Kidney Disease

Patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis with end-stage kidney disease had higher mortality and infection rates, but lower relapse rates, than those reported for patients ANCA-associated vasculitis without end-stage kidney disease, according to a systematic review and meta-analysis published in Seminars in Arthritis and Rheumatism.

“This systematic review and meta-analysis was undertaken to gather the existing evidence for outcomes in ANCA-associated vasculitis patients after development of end-stage kidney disease on renal replacement therapy to provide guidance for managing these patients and to guide future research opportunities,” wrote corresponding author Lillian Barra, MD, MPH, FRCPC, London Health Sciences Centre and Western University, London, Ontario, Canada, and study coauthors.

The meta-analysis included outcomes from 22 retrospective, prospective, and case series studies spanning 952 adult patients with end-stage kidney disease and 3600 person-years of follow-up. The pooled mortality rate was 10.90 per 100 person-years, according to the study. Pooled 1-year survival was 80.9%, and pooled 5-year survival was 61.0%.

The meta-analysis also identified a pooled severe infection rate of 66.57 per 100 person-years and a pooled relapse rate of 6.22 per 100 person-years.

The single pediatric study that met inclusion criteria included a total nine patients and reported a mortality rate of 11.7 ± 1.9 deaths per 100 person-years.

“More prospective research exploring the role of immunosuppression after end-stage kidney disease is needed,” researchers advised.

Reference
Pope V, Sivashanmugathas V, Moodley D, Gunaratnam L, Barra L. Outcomes in ANCA-associated vasculitis patients with end-stage kidney disease on renal replacement therapy—a meta-analysis. Semin Arthritis Rheum. 2023;60:152189. doi: 10.1016/j.semarthrit.2023.152189