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Abstract: SA-PO420

Risk Factors for Progression to ESRD in Patients with ANCA Associated Vasculitis - Experiences from a Chinese Single Center

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Xu, Ying, The kidney disease center, The first affiliated hospital, College of Medicine, Zhejiang University, Hangzhou, China
  • Han, Fei, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, ZheJiang, China
  • Chen, Jianghua, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
Background

Although ANCA associated vasculitis (AAV) is not a common disease, AAV renal damage is the leading rapidly progressive glomerulonephritis leading to end-stage renal disease (ESRD). If we can screen out the risk factors for progression to ESRD, it will be valuable for the treatment.

Methods

498 AAV patients diagnosed from October 23, 1999 to February 15, 2017 were enrolled, the latest follow up date was February 21, 2018. The general conditions, clinical manifestations, laboratory investigations, renal biopsy results, treatment regimens and prognosis (renal/patient survival) were analyzed.

Results

Among the 498 cases, there were 283 females and 215 males. The average onset age was 60.9±14.5 years old (10-90). MPO-AAV was more than PR3-AAV (91% vs 9%). 486 patients (97.6%) had renal impairment. 216 patients (44.4%) received renal biopsy. 54 patients (11.1%) received dialysis at the onset and 11 of them get rid of dialysis. Apart from 56 patients (11.2%) lost to follow up and 53 patients (10.6%) died, we divided patients to ESRD group (n=145) and Stable group (n=302). We compared the baseline data of the two groups (age, sex, onset to diagnosis time, clinical presentation, BVAS score and lab investigation) and treatment regimen (whether plasma replacement, whether or not glucocorticoid pulse therapy). The results showed that the parameters associated with the progression of the patients to ESRD included the type of vasculitis (P=0.016), the combination of hypertension (P<0.001), the combination of fever (P=0.048), hemoglobin level, platelet level, 24-hour proteinuria, serum creatinine level, eGFR level and the need for dialysis (P<0.001). Multiple factor Cox regression analysis showed that daily urine protein (3.21±2.46 vs 1.71±1.61g, 95% CI 0.67-0.99, P=0.041) and eGFR level (9.25±6.10 vs 44.37±40.76ml/min, 95% CI 1.018-1.159, P=0.013) were independent risk factors for the patient's progression to ESRD.

Conclusion

The prognosis of renal function was poor in patients with heavier proteinuria or lower eGFR level. Due to the low rate of renal biopsy, we found that the segmental crescentic ratio and fibrinous necrosis were associated with deterioration of renal function, but not independent risk factors.