The clinical course of ANCA small-vessel vasculitis on chronic dialysis

Division of Nephrology and Hypertension, UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Kidney International (Impact Factor: 8.56). 07/2009; 76(6):644-51. DOI: 10.1038/ki.2009.218
Source: PubMed


Antineutrophil cytoplasmic autoantibody (ANCA)-associated small-vessel vasculitis frequently affects the kidney. Here we describe the rates of infection, disease relapse, and death in patients with ANCA small-vessel vasculitis before and after end-stage renal disease (ESRD) in an inception cohort study and compare them to those of patients with preserved renal function. All patients had biopsy-proven ANCA small-vessel vasculitis. Fisher's exact tests and Wilcoxon rank sum tests were used to compare the characteristics by ESRD status. ESRD follow-up included time on dialysis with transplants censored. Over a median follow-up time of 40 months, 136 of 523 patients reached ESRD. ESRD was associated with new-onset ANCA small-vessel vasculitis in 51% of patients, progressive chronic kidney disease without active vasculitis in 43%, and renal relapse in 6% of patients. Relapse rates of ANCA small-vessel vasculitis, reported as episodes/person-year, were significantly lower on chronic dialysis (0.08 episodes) compared with the rate of the same patients before ESRD (0.20 episodes) or with patients with preserved renal function (0.16 episodes). Infections were almost twice as frequent among patients with ESRD on maintenance immunosuppressants and were an important cause of death. Given the lower risk of relapse and higher risk of infection and death, we suggest that immunosuppression be geared to patients with ESRD who present with active vasculitis.

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Available from: Sofia Lionaki, Jul 28, 2014
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    • "Relapse of ANCA-associated vasculitis is significantly less frequent (0.08 episodes/personyear ) in ESRD patients compared with patients with preserved renal function (0.16-0.20 episodes/person-year), but infection, an important cause of death is almost double in frequency in ESRD (Lionaki et al. 2009). Therefore, immunosuppression in patients with ESRD may be limited to patients with active vasculitis. "

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