Session Title: Vasculitis I
Session Type: Abstract Submissions (ACR)
Despite dramatic outcome improvement in ANCA-associated vasculitides (AAV), renal involvement is still leading to end-stage renal disease (ESRD) in 20-30% of patients. This study evaluated the survival of AAV patients in chronic dialysis in France.
All patients starting chronic renal replacement therapy (RRT) secondary to AAV registered in the Renal Epidemiology and Information Network (REIN) registry, between January 1st 2002 and December 31st2011, were included in the study. Survival analysis, censored for renal transplantation, renal function recovery and lost to follow-up, was performed with Kaplan-Meier in AAV patients. AAV patients were compared to non-AAV patients in chronic dialysis matched for age, gender and main comorbidities.
A total of 425 patients starting RRT were registered in the REIN registry (0.7% of incident patients in chronic RRT in France), comprising 166 (39%) patients with microscopic polyangiitis (MPA) and 259 (61%) patients with granulomatosis with polyangiitis (GPA). Renal disease was biopsy-proven for 307 (72%) of them. Within a median follow-up of 23 months, 58 (14%) patients received a renal allograft, 19 (4%) had a renal function recovery allowing dialysis withdrawal and 348 remained in dialysis. Median survival in dialysis was 5.35 years (95% CI, 4.4-6.3) and survival rates at 1, 3 and 5 years were respectively 83%, 65% and 49% in AAV patients, without difference between GPA and MPA. A total of 143 (41%) patients died, after a median of 16 months in dialysis. Causes of death were: cardiovascular (29%), infectious (20%), malnutrition (13%), malignancies (4%), AAV relapse (2%), other miscellaneous (14%) and unknown (18%). After Cox2 multivariate logistic regression, only 3 risk factors were independently associated with mortality in AAV patients: age (HR=1.05 per year, p<0.001), peripheral artery disease (HR=2.62, p=0.003) and the absence of autonomy (HR=2.43 p<0.001). Survival of AAV patients did not differ from that of the 792 non-AAV matched patients in chronic dialysis, but infectious mortality was higher in AAV patients (20% vs 8% p<0,001). The limitation of this study is the absence of registration of immunosuppressive regimen and non fatal AAV relapses in the REIN registry.
Survival of AAV patients in chronic dialysis, although poor, is comparable to the survival of non-AAV matched patients in dialysis, with a similar burden of cardio-vascular mortality, and a higher infectious mortality. This calls for cardio-vascular risk prevention and monitoring of vaccination status in this population.
C. Couchoud Sr.,
J. C. Delarozière,
L. Chiche Sr.,
J. R. Harle,
N. Jourde-Chiche Sr.,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/survival-of-patients-with-anca-associated-vasculitides-in-chronic-dialysis-in-france-from-2002-to-2011-data-from-the-national-rein-registry/