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2016 ; 68
(7
): 1711-20
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Trends in Long-Term Outcomes Among Patients With Antineutrophil Cytoplasmic
Antibody-Associated Vasculitis With Renal Disease
#MMPMID26814428
Rhee RL
; Hogan SL
; Poulton CJ
; McGregor JA
; Landis JR
; Falk RJ
; Merkel PA
Arthritis Rheumatol
2016[Jul]; 68
(7
): 1711-20
PMID26814428
show ga
OBJECTIVE: It is still not clear how advances in the management of antineutrophil
cytoplasmic antibody (ANCA)-associated vasculitis (AAV) have impacted long-term
outcomes. We undertook this study to examine changes over 25 years in long-term
clinical outcomes, including the impact of renal function at diagnosis (a
potential marker of time to disease detection) and the duration of
cyclophosphamide use in AAV patients with renal involvement. METHODS: We included
ANCA-positive patients with biopsy-proven AAV diagnosed between 1985 and 2009 who
were followed up in the Glomerular Disease Collaborative Network inception
cohort. Outcomes included the composite outcome of end-stage renal disease (ESRD)
or death as well as relapse. Cox proportional hazards or competing risks
regression models were adjusted for potential baseline confounders. RESULTS: Data
from 554 patients were included in the analysis. There was a decreasing 5-year
risk of ESRD or death over time (P?0.001 by log rank test for trend). After
adjustment for baseline characteristics, the risk of relapse was similar across
the time periods (P?=?0.45 by test for trend). Serum creatinine level at baseline
was the only significant predictor of an increased risk of ESRD or death (hazard
ratio 1.11 per 1 mg/dl of serum creatinine [95% confidence interval 1.04-1.18],
P?=?0.002). CONCLUSION: In patients with renal disease secondary to AAV, over 25
years the risk of ESRD or death has decreased but the risk of relapse has not
changed. A higher serum creatinine level at diagnosis is associated with a higher
risk of ESRD or death, suggesting that earlier disease detection is potentially
an important measure to improve outcomes in AAV.