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Clin J Am Soc Nephrol. 2015 Jul 7;10(7):1128-35. doi: 10.2215/CJN.00480115. Epub 2015 Jun 22.

Outcome and treatment of elderly patients with ANCA-associated vasculitis.

Author information

1
Departments of Nephrology and Medical and Health Sciences and maria.weiner@liu.se.
2
University College London Centre for Nephrology, Royal Free Hospital, London, United Kingdom;
3
Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, United Kingdom;
4
Department of Nephrology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic;
5
Department of Medicine, Imperial College London, London, United Kingdom;
6
Department of Renal Medicine, Karolinska University Hospital, and Department of Clinical Sciences, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden; and.
7
Department of Nephrology, Lund University, Skåne University Hospital, Lund and Malmö, Sweden.
8
Rheumatology and Clinical and Experimental Medicine, Linköping University, Linköping, Sweden;
9
Departments of Nephrology and Medical and Health Sciences and.

Abstract

BACKGROUND AND OBJECTIVES:

ANCA-associated vasculitis is commonly found in elderly patients, but there are few data concerning outcome and treatment in the highest age groups.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

Consecutive patients (N=151) presenting between 1997 and 2009 were retrospectively included from local registries in six centers in Sweden, the United Kingdom, and the Czech Republic if diagnosed with microscopic polyangiitis or granulomatosis with polyangiitis at age ≥75 years during the study period. Patients were followed until 2 years from diagnosis or death. Data on survival and renal function were analyzed with respect to age, sex, ANCA specificity, renal function, C-reactive protein, comorbidities, and Birmingham Vasculitis Activity Score at diagnosis as well as treatment during the first month.

RESULTS:

Median follow-up was 730 days (interquartile range, 244-730). Overall 1-year survival was 71.5% and 2-year survival was 64.6%. Older age, higher creatinine, and lower Birmingham Vasculitis Activity Score were associated with higher mortality in multivariable analysis. Patients who were not treated with standard immunosuppressive therapy had significantly worse survival. Renal survival was 74.8% at 1 year. No new cases of ESRD occurred during the second year. High creatinine at diagnosis was the only significant predictor of renal survival in multivariable analysis.

CONCLUSIONS:

ANCA-associated vasculitis is a disease with substantial mortality and morbidity among elderly patients. This study showed a better prognosis for those who received immunosuppressive treatment and those who were diagnosed before having developed advanced renal insufficiency.

KEYWORDS:

ANCA; GN; survival; vasculitis

Comment in

PMID:
26100457
PMCID:
PMC4491279
DOI:
10.2215/CJN.00480115
[Indexed for MEDLINE]
Free PMC Article

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