Outcomes in ANCA-associated vasculitis patients with end-stage kidney disease on renal replacement therapy-A meta-analysis

Victor Pope; Varunaavee Sivashanmugathas; Dirusha Moodley; Lakshman Gunaratnam; Lillian Barra

doi:10.1016/j.semarthrit.2023.152189

Outcomes in ANCA-associated vasculitis patients with end-stage kidney disease on renal replacement therapy-A meta-analysis

Semin Arthritis Rheum. 2023 Jun:60:152189. doi: 10.1016/j.semarthrit.2023.152189. Epub 2023 Mar 11.

Authors

Victor Pope¹, Varunaavee Sivashanmugathas¹, Dirusha Moodley¹, Lakshman Gunaratnam², Lillian Barra³

Affiliations

¹ Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
² Division of Nephrology, Department of Medicine, London Health Sciences Centre and Western University, London, Ontario, Canada.
³ Division of Rheumatology, Department of Medicine, London Health Sciences Centre and Western University, London, Ontario, Canada. Electronic address: lillian.barra@sjhc.london.on.ca.

PMID: 36931168
DOI: 10.1016/j.semarthrit.2023.152189

Abstract

Background: End-stage kidney disease (ESKD) is associated with poor prognosis in patients with anti-neutrophilic cytoplasmic antibody (ANCA)-associated vasculitis (AAV). This study summarizes the existing evidence regarding outcomes in AAV patients with ESKD on renal replacement therapy.

Methods: Searches of the MEDLINE and Embase databases were performed from inception until December 2021. Any study reporting outcomes after ESKD in patients with AAV on haemodialysis or peritoneal dialysis was included. The mortality rate per 100 person-years (100 py) calculated with a random-effects meta-analysis model was the primary outcome. Rates of infections and relapses were secondary outcomes.

Results: 2470 citations were found; 22 studies of 952 adult patients with over 3600 person-years of follow-up were included. The pooled mortality rate was 10.90 per 100 py (95% CI: 7.11 - 14.68, I² = 90.8%). The pooled 1-year survival was 80.9% (95% CI: 75.6 - 86.1%, I² = 86.1%) while the pooled 5-year survival was 61.0% (95% CI: 46.0 - 76.0%, I² = 0.0%). The pooled severe infection rate was 66.57 per 100 py (95% CI: 13.64 - 119.50, I² = 99.6%). The pooled relapse rate was 6.22 per 100 py (95% CI: 4.64 - 7.80, I² = 46.6%). Only 1 paediatric study met the inclusion criteria and reported a mortality rate of 11.7 ± 1.9 deaths per 100 py (95% CI: 0.23 - 23.20) amongst 9 patients.

Conclusions: Patients with AAV and ESKD have a lower risk of relapse, but higher infection and mortality rates. More prospective research exploring the role of immunosuppression after ESKD is needed.

Keywords: ANCA-associated vasculitis; Dialysis; Meta-analysis; end-stage kidney disease; renal replacement therapy.

Publication types

Meta-Analysis

MeSH terms

Adult
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis* / complications
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis* / therapy
Antibodies, Antineutrophil Cytoplasmic
Child
Chronic Disease
Humans
Kidney Failure, Chronic* / therapy
Prospective Studies
Recurrence
Renal Replacement Therapy
Retrospective Studies

Substances

Antibodies, Antineutrophil Cytoplasmic