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Deprecated: Implicit conversion from float 233.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Arthritis+Rheumatol 2016 ; 68 (7): 1711-20 Nephropedia Template TP
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Trends in Long-Term Outcomes Among Patients with ANCA-Associated Vasculitis with Renal Disease #MMPMID26814428
Arthritis Rheumatol 2016[Jul]; 68 (7): 1711-20 PMID26814428show ga
Objective: How advances in the management of ANCA (anti-neutrophil cytoplasmic antibody)-associated vasculitis (AAV) have impacted long-term outcomes is still unclear. We examined temporal 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 duration of cyclophosphamide use in AAV patients with renal involvement. Methods: ANCA-positive, biopsy-proven patients with AAV diagnosed in 1985?2009 followed in the Glomerular Disease Collaborative Network inception cohort were included. Outcomes included the composite outcome of end-stage renal disease (ESRD) or death as well as relapse. Cox proportional hazard or competing risk regression models were adjusted for potential baseline confounders. Results: Data from 544 patients were included in the analysis. There was a decreasing 5-year risk of ESRD or death over time (log rank test for trend: p < 0.001). After adjustment for baseline characteristics, the risk of relapse was similar across the time periods (test for trend: p = 0.45). Serum creatinine at baseline was the only significant predictor of an increased risk of ESRD or death (HR 1.11 per 1 mg/dL of serum creatinine [95% CI 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 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.