Abstract: TH-OR070

Treatment and Outcomes of the ANCA Associated Vasculitis in the Very Elderly – A Single Centre Experience

Session Information

Category: Geriatric Nephrology

  • 901 Geriatric Nephrology

Author

  • Chaggar, Turren tarun Singh, Epsom and St Helier NHS Trust, London, United Kingdom
Background

ANCA-associated vasculitis has a peal incidence between 65-74 years of age, and not uncommonly presents in the very elderly (>80yrs). Decisions regarding immunosuppression in the very elderly can be challenging, given likely co-morbidities and general frailty, and on treatment and outcomes in this age group is lacking.

Methods

Patients were identified retrospectively from the local renal database. A total of 231 patients presented with ANCA associated vasculitis between 2006 and 2015. Data from patients >= 80 years during the study period were collected. Follow-up was until May 2017. The collected data were analysed with respect to age, sex, renal function at diagnosis, patient and renal survival, induction and maintenance treatment and disease relapse

Results

We identified 32 patients from this cohort, mean age of 83.5 yrs (range 80- 90 years), mean follow-up period of 35.5 months (range 0.2 – 106). Of these, 14 were PR3 positive and 18 were MPO positive. Overall survival to completion of induction therapy at 3 months was 91% (29/32) and 1 year survival was 90% (26/29). Mean creatinine at presentation was 406 µmol/L and 38% (12/32) required renal replacement therapy (RRT) within 72 hours of presentation. Induction of remission was achieved using corticosteroids with either cyclophosphamide (25/32), MMF (1/32) or rituximab (1/32). In two patients azathioprine was used with corticosteroids as first line therapy. N=6 had Plasma Exchange in addition to RRT. Of these, 4 were RRT independent at 3 months. Renal survival was 79% (23/29) at 3 months and 85% (22/26) at 1 year. No patients progressed to ESRD after 3 months. Disease relapse occurred in 2 patients, with a mean time to relapse of 21.5 months.

Conclusion

AAV is a disease with substantial mortality and morbidity among elderly patients. The results of this retrospective study showed that very elderly patients can benefit from immunosuppressive therapy with good outcomes to 3 month and 1 year survival. Relapse rates are low. Dialysis independence can be achieved in those patients requiring RRT on admission and this treatment ensures that patients are maintained off RRT upto a median of 35.5 months follow-up.