Long-term survival and mortality characteristics of patients with ANCA-associated vasculitis on maintenance hemodialysis: a propensity score-matched study from the Wuhan registry (2017-2025).

BACKGROUND

Registry-based data on the long-term survival of ANCA-associated vasculitis (AAV) patients on maintenance hemodialysis (MHD) in China are limited, particularly across the COVID-19 pandemic period.

METHODS

Data were obtained from the Wuhan Dialysis Registry (2017–2025), including 9,430 MHD patients with complete data, of whom 54 (0.57%) had AAV. Propensity score matching (1:3) generated 54 AAV and 162 non-AAV patients. All-cause survival was compared using Kaplan-Meier methods. Cox proportional hazards models were used to evaluate mortality risk factors among AAV patients.

RESULTS

Overall survival was comparable between AAV and matched non-AAV patients. 1-, 2-, 3-, and 5-year survival rates were 91.8%, 84.2%, 75.2%, and 67.5% in AAV, versus 94.5%, 85.5%, 81.2%, 67.7% in non-AAV patients (P = 0.737). Among 12 deaths in AAV patients (median age 74.0 years, median dialysis vintage 21.0 months), infection was the leading cause (8/12, 66.7%), including COVID-19 in 3 cases (25.0%); no deaths were attributed to AAV relapse. Univariable Cox regression identified that older age (HR 1.09, P = 0.028), lower hemoglobin (HR 0.96, P = 0.041), and central venous catheter use (HR 4.01, P = 0.038) were significantly associated with increased mortality in AAV patients. Multivariable analysis was not performed due to limited events (n = 12).

CONCLUSIONS

In this registry-based cohort, overall survival was comparable between AAV and non-AAV patients on maintenance hemodialysis. Infection was the leading cause of death, with no deaths attributed to AAV relapse. These findings highlight the critical importance of infection prevention strategies in this vulnerable population.