Survival of patients with ANCA-associated vasculitis on chronic dialysis: data from the French REIN registry from 2002 to 2011

Romeu, M.; Couchoud, Cécile; Delarozière, Jean-Christophe; Burtey, Stéphane; Chiche, Laurent; Harlé, Jean‐Robert; Gondouin, Bertrand; Brunet, Philippe; Berland, Yvon; Jourde-Chiche, Noémie

doi:10.1093/qjmed/hcu043

Cited by 37 publications

(30 citation statements)

References 28 publications

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“…Frailty has already been described as an independent risk factor of mortality in chronic dialysis (22,23), and CHF is a major prognostic factor in patients with ALA (17). The surprising association of high BP at the initiation of dialysis with a reduced risk of death has been reported before in dialysis (24) and could be of particular relevance in patients with ALA, where low BP can be caused by CHF or dysautonomia.…”

Section: Discussionmentioning

confidence: 81%

Trends in Survival and Renal Recovery in Patients with Multiple Myeloma or Light-Chain Amyloidosis on Chronic Dialysis

Decourt¹,

Gondouin²,

Delaroziere

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives Monoclonal gammopathies (MGs) with renal involvement can lead to ESRD caused by myeloma cast nephropathy (MCN), immunoglobulin light chain amyloidosis (ALA), or light-chain deposition disease (LCDD). Few studies have focused on the prognosis of patients with MG on chronic dialysis. We evaluated the outcomes of patients with MG incident on chronic dialysis in France.Design, setting, participants, & measurements All incident patients registered in the Renal Epidemiology and Information Network Registry between 2002 and 2011 with ESRD caused by ALA, LCDD, or MCN were included. Patient's survival, censored for renal transplantation, renal recovery, and loss to follow-up, as well as renal outcomes were analyzed and compared with a control group. Risk factors and causes of death were analyzed.Results We included 1459 patients, comprising 265 (18%) patients with ALA, 334 (23%) patients with LCDD, and 861 (59%) patients with MCN. Median age was 72 years, and 56% were men. Median follow-up was 13.1 months. Renal recovery was observed in 9.1% of patients and more frequent after 2006. Kidney transplantation was rare in this population (2.3%). Among 1272 patients who remained on dialysis, 67% died. Median survival on dialysis was 18.3 months. Main causes of death were malignancies (34.4%), cardiovascular diseases (18%), infections (13.3%), and cachexia (5.2%). Independent risk factors of death were age (hazard ratio [HR], 1.03 per year increase; 95% confidence interval [95% CI], 1.02 to 1.03), frailty (HR, 1.93; 95% CI, 1.58 to 2.36), congestive heart failure (HR, 1.54; 95% CI, 1.23 to 1.93), and dialysis initiation on a central catheter (HR, 1.40; 95% CI, 1.11 to 1.75). Factors associated with a lower risk of death were year of dialysis initiation (HR, 0.95 per year increase; 95% CI, 0.91 to 0.99) and high BP (HR, 0.80; 95% CI, 0.67 to 0.97).Conclusions Survival of patients with ALA, LCDD, or MCN on chronic dialysis is poor but has improved over time. Progressive malignancy is the main cause of death in this population. Renal recovery has increased since 2006.

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Section: Discussionmentioning

confidence: 81%

Trends in Survival and Renal Recovery in Patients with Multiple Myeloma or Light-Chain Amyloidosis on Chronic Dialysis

Decourt¹,

Gondouin²,

Delaroziere

et al. 2016

Clinical Journal of the American Society of Nephrology

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“…Mortality comparisons accounting for case-mix differences were, again, not performed. With the exception of this subgroup analysis, most other studies examining mortality outcomes after ERSD development in GN were restricted to single GN subtypes (3,(15)(16)(17) or combined subtypes into a single GN category (18,19), precluding direct comparisons across GN subtypes.…”

Section: Discussionmentioning

confidence: 99%

Patient Characteristics and Outcomes by GN Subtype in ESRD

O’Shaughnessy

Montez‐Rath

Lafayette

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Outcomes-based research rarely focuses on patients with ESRD caused by GN. The hypotheses were that the GN subtype would clinically discriminate patient groups and independently associate with survival after ESRD therapy initiation.Design, setting, participants, & measurements Data were extracted from the US Renal Data System for adult patients with incident (1996-2011) ESRD attributed to six GN subtypes: FSGS, IgA nephropathy (IgAN), membranous nephropathy, membranoproliferative glomeruonephritis, lupus nephritis (LN), and vasculitis. ESRD attributed to diabetes and autosomal dominant polycystic kidney disease served as non-GN comparators. Unadjusted and adjusted mortality hazard ratios (aHRs) with 95% confidence intervals (95% CIs) were estimated using Cox regression (reference, IgAN). Models sequentially adjusted for sociodemographic (model 2), comorbidity/laboratory (model 3), and ESRD treatment modality (model 4) variables.Results Among 84,301 patients with ESRD attributed to GN, the median age ranged from 39 (LN) to 66 (vasculitis) years, male sex ranged from 18% (LN) to 68% (IgAN), and black race ranged from 7% (IgAN) to 49% (LN). Patients with IgAN had the fewest comorbidities and lowest use of hemodialysis (70.1%). After a median followup of 2.5 (interquartile range, 1.0-4.9) years, crude mortality was lowest in IgAN (3.7 deaths/100 person years). Compared to IgAN, adjusted mortality was highest in LN (model 4 aHR=1.75; 95% CI, 1.68 to 1.83) and in diabetes (aHR=1.73; 95% CI, 1.67 to 1.79), and was also higher in all other GN subtypes (membranous nephropathy: aHR=1.23; 95% CI, 1.17 to 1.29; FSGS: aHR=1.37; 95% CI, 1.32 to 1.42; membranoproliferative GN: aHR=1.38; 95% CI, 1.31 to 1.45; vasculitis: aHR=1.51; 95% CI, 1.45 to 1.58) and in autosomal dominant polycystic kidney disease (aHR=1.22; 95% CI, 1.18 to 1.27).Conclusions This study exposes substantial heterogeneity across GN subtypes at ESRD therapy initiation and identifies independent associations between GN subtype and post-ESRD mortality. These survival discrepancies warrant further study, and the utility of current research practice to group GN subtypes together when evaluating ESRD outcomes should be questioned.

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“…The outcome of patients with AAV who receive a kidney transplant is good and the relapse rate low [19,20] although registry data from New Zealand and Australia suggest that patients with MPO-ANCA have worse graft and overall survival compared to non-vasculitic patients whereas patients with PR3-ANCA had comparable outcomes [21]. The survival of patients with AAV on dialysis is similar to dialysis patients without vasculitis but infection may be more common [21,22]. …”

Section: Organ Failurementioning

confidence: 99%

Risks of treatments and long-term outcomes of systemic ANCA-associated vasculitis

Floßmann

2015

La Presse Médicale

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Survival of patients with ANCA-associated vasculitis on chronic dialysis: data from the French REIN registry from 2002 to 2011

Abstract: Survival of AAV patients in chronic dialysis, although poor, was comparable to survival of non-AAV controls on dialysis. There was a similar burden of cardiovascular mortality, but higher infectious mortality.

Cited by 37 publications

References 28 publications

Trends in Survival and Renal Recovery in Patients with Multiple Myeloma or Light-Chain Amyloidosis on Chronic Dialysis

Trends in Survival and Renal Recovery in Patients with Multiple Myeloma or Light-Chain Amyloidosis on Chronic Dialysis

Patient Characteristics and Outcomes by GN Subtype in ESRD

Risks of treatments and long-term outcomes of systemic ANCA-associated vasculitis

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