J Rheum Dis.  2023 Oct;30(4):251-259. 10.4078/jrd.2023.0031.

Recovery and long-term renal outcome of patients with antineutrophil cytoplasmic antibody-associated vasculitis who are on dialysis at presentation

• Lee YJ
• Ahn SM
• Oh JS
• Kim YG
• Lee CK
• Yoo B
• Hong S

• KMID: 2546241
• DOI: http://doi.org/10.4078/jrd.2023.0031

Abstract

Objective
Renal involvement in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) can lead to severe renal dysfunction requiring dialysis at diagnosis. We aimed to study the clinical and pathologic characteristics of patients with AAV dependent on dialysis at presentation and the long-term renal outcomes of patients who recovered from dialysis.
Methods
This retrospective study analyzed data of patients diagnosed with AAV who were on dialysis from July 2005 to May 2021 at a single tertiary center in Korea.
Results
Thirty-four patients were included in the study (median age: 64.5 years, females: 61.8%), of which 13 discontinued and 21 continued dialysis. The proportion of normal glomeruli (p<0.001) and interstitial fibrosis (p=0.024) showed significant differences between both groups. Multivariable analysis showed that the proportion of normal glomeruli was associated with dialysis discontinuation (odds ratio=1.29, 95% confidence interval 0.99~1.68, p=0.063), although without statistical significance. Treatment modalities, including plasmapheresis, did not show significance with dialysis discontinuation. In the follow-up analysis of 13 patients who had discontinued dialysis for a median of 81 months, 12 did not require dialysis, and their glomerular filtration rate values significantly increased at follow-up time compared to when they stopped dialysis (37.5 [28.5~45.5] vs. 24.0 [18.5~30.0] mL/ min/1.73 m²; p=0.008).
Conclusion
Approximately 38% of AAV patients on dialysis discontinued dialysis, and the recovered patients had improved renal function without dialysis during longer follow-up. Patients with AAV on dialysis should be given the possibility of dialysis discontinuation and renal recovery, especially those with normal glomeruli in kidney pathology.

Keyword

Dialysis; Anti-neutrophil cytoplasmic antibody-associated vasculitis

Figure

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  Fig. 1 Patient selection flowchart. AVV: anti-neutrophil cytoplasmic antibody-associated vasculitis.

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  Fig. 2 The comparison of values of estimated glomerular filtration rate (eGFR) of patients (n=12) with dialysis discontinuation between the time of dialysis discontinuation and time after the follow-up period.

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