Characteristics and Outcomes of Granulomatosis With Polyangiitis (Wegener) and Microscopic Polyangiitis Requiring Renal Replacement Therapy: Results From the European Renal Association-European Dialysis and Transplant Association Registry


Por: Hruskova, Z, Stel, V, Jayne, D, Aasarod, K, De Meester, J, Ekstrand, A, Eller, K, Heaf, J, Hoitsma, A, Jimenez, C, Ravani, P, Wanner, C, Tesar, V and Jager, K

Fecha de Publicación: 01/10/2015
Categoría: Nephrology

Resumen:
Background: This study describes the incidence and outcomes of European patients requiring renal replacement therapy (RRT) for kidney failure due to antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Study Design: Cohort study. Setting & Participants: 12 renal registries providing individual RRT patient data to the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry in 1993-2012 participated. Predictor: Cause of primary kidney disease: AAV (ie, granulomatosis with polyangiitis [Wegener] and microscopic polyangiitis) versus 3 separate matched control groups without AAV: (1) primary glomerulonephritis, (2) diabetes mellitus, and (3) disease other than diabetes mellitus as the cause of primary kidney disease, including glomerulonephritis (termed "nondiabetes"). Outcomes: Incidence, causes of death, and survival. Measurements: ERA-EDTA primary renal disease codes. Results: 2,511 patients with AAV (1,755, granulomatosis with polyangiitis; 756, microscopic polyangiitis) were identified, representing an incidence of 1.05 per million population (pmp) for granulomatosis with polyangiitis (predominating in Northern Europe) and 0.45 pmp for microscopic polyangiitis (prevailing in Southern Europe). Kidney transplantation was performed in 558 (22.2%) patients with vasculitis. The 10-year probability for survival on RRT after day 91 was 32.5% (95% CI, 29.9%-35.1%) in patients with vasculitis. Survival on RRT after day 91 did not differ between AAV and matched nondiabetes patients. Patient and transplant survival after kidney transplantation, adjusted for time period and country, was better in AAV than in matched nondiabetes patients (HRs of 0.81 [95% CI, 0.67-0.99] and 0.82 [95% CI, 0.69-0.96], respectively). Limitations: No data for extrarenal manifestations, treatment, and relapses. Conclusions: Geographical differences in the incidence of RRT for kidney failure due to granulomatosis with polyangiitis and microscopic polyangiitis copied their distribution in the general population. Overall survival on RRT after day 91 for patients with AAV was similar to that for patients with nondiabetes diagnoses. Our results suggest that patients with AAV are suitable candidates for kidney transplantation with favorable survival outcomes. (C) 2015 by the National Kidney Foundation, Inc.

Direcciones
Hruskova, Z: Charles Univ Prague, Gen Univ Hosp, Dept Nephrol, Prague 12808 2, Czech Republic; Charles Univ Prague, Fac Med 1, Prague 12808 2, Czech Republic
Stel, VS: Univ Amsterdam, Acad Med Ctr, Dept Med Informat, ERA EDTA Registry, NL-1105 AZ Amsterdam, Netherlands
Jayne, D: Univ Cambridge, Dept Med, Cambridge CB2 2QQ, England
Aasarod, K: St Olavs Univ Hosp, Dept Renal Med, Trondheim, Norway
De Meester, J: AZ Nikolaas, Dept Nephrol Dialysis & Hypertens, St Niklaas, Belgium
Ekstrand, A: Helsinki Univ Hosp, Dept Med, Div Nephrol, Helsinki, Finland
Eller, K: Med Univ Graz, Dept Internal Med, Clin Div Nephrol, Graz, Austria
Heaf, JG: Univ Copenhagen, Herlev Hosp, Dept Nephrol, Copenhagen, Denmark
Hoitsma, A: Radboud Univ Nijmegen, Div Nephrol, Med Ctr, NL-6525 ED Nijmegen, Netherlands
Jimenez, CM: Ctr Publ Hlth Res CSISP FISABIO, Valencia, Spain
Ravani, P: Univ Calgary, Med, Calgary, AB, Canada; Univ Calgary, Commun Hlth Sci, Calgary, AB, Canada
Wanner, C: Univ Hosp, Dept Med, Div Nephrol, Wurzburg, Germany
Tesar, V: Charles Univ Prague, Gen Univ Hosp, Dept Nephrol, Prague 12808 2, Czech Republic; Charles Univ Prague, Fac Med 1, Prague 12808 2, Czech Republic
Jager, KJ: Univ Amsterdam, Acad Med Ctr, Dept Med Informat, ERA EDTA Registry, NL-1105 AZ Amsterdam, Netherlands
ISSN: 15236838





AMERICAN JOURNAL OF KIDNEY DISEASES
Editorial
W. B. Saunders Co., Ltd., 1600 JOHN F KENNEDY BOULEVARD, STE 1800, PHILADELPHIA, PA 19103-2899 USA, Reino Unido
Tipo de documento: Article
Volumen: 66 Número: 4
Páginas: 613-620s
WOS: 000361820100017
ID de PubMed: 25975963

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