Effect of Baseline Dialysis and Plasma Exchange on Renal Prognosis in Patients With Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis.
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Vignac Maxime, Nezam Dorian, Grolleau François, Morel Pauline, Titeca-Beauport Dimitri, Faguer Stanislas, Karras Alexandre, Solignac Justine, Jourde-Chiche Noémie, Maurier François, Sakhi Hamza, El Karoui Khalil, Mesbah Rafik, Carron Pierre Louis, Audard Vincent, Ducloux Didier, Paule Romain, Augusto Jean-François, Aniort Julien, Tiple Aurélien, Rafat Cédric, Beaudreuil Séverine, Puéchal Xavier, Gobert Pierre, Massy Ziad, Hanrotel Catherine, Bally Stéphane, Martis Nihal, Durel Cécile-Audrey, Desbuissons Geoffroy, Godmer Pascal, Hummel Aurélie, Perrin François, Néel Antoine, De Moreuil Claire, Goulenok Tiphaine, Guerrot Dominique, Grange Steven, Foucher Aurélie, Deroux Alban, Dervaux Alexandra, Guilbeau-Frugier Céline, Modesto-Segonds Anne, Nochy Dominique, Daniel Laurent, Moktefi Anissa, Rabant Marion, Guillevin Loïc, Régent Alexis, Porcher Raphaël, Terrier Benjamin, French Vasculitis Study Group
Аннотация
METHODS: This retrospective multicenter study evaluated the 1-year composite end point of death or end-stage kidney disease (ESKD) in patients with biopsy-proven renal AAV involvement.
RESULTS: Of the 394 patients included, 105 (26.6%) were on dialysis at baseline. Of these, 60 (57.1%) reached the composite end point compared with 29 patients (10.0%) who were not on RRT at baseline (P < 0.001). On multivariate analysis, age and sex were not associated with the composite outcome (P = 0.945 and P = 0.154, respectively); however, myeloperoxidase (MPO)-ANCA was (odds ratio [OR]: 3.60; 95% confidence interval [CI]: 1.79-7.60), as was a high baseline histologic renal risk score (OR: 1.29; 95% CI 1.17-1.44). The most strongly associated factor remained the need for dialysis at baseline (OR: 10.91; 95% CI: 5.52-22.70). Of the 91 patients surviving after requiring dialysis at baseline, 45 were weaned from RRT (49.5%) at 1 year, and PLEX was independently associated with a reduced risk of the composite outcome (OR: 0.23, 95% CI: 0.05-0.80).
CONCLUSION: MPO-ANCA, need for dialysis, and high histological renal risk score at baseline were associated with the 1-year composite end point of death or ESKD. Almost half of the patients on dialysis at baseline were off dialysis at 1 year, with a better prognosis in those who had received PLEX.