Abstract: SA-PO645
ANCA-Associated Vasculitis with AKI: KDIGO AKI Stage, Short-Term Recovery, and Long-Term Outcome
Session Information
- Glomerular Diseases: ANCA, Anti-GBM, Kidney Biopsy
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Huang, Xiaohan, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Chen, Liangliang, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Ma, Yanhong, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Yu, Binfeng, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Han, Fei, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
Background
To study KDIGO AKI stages and its association with short-term and long-term outcome in patients with ANCA associated vasculitis.
Methods
We retrieved data of 154 patients who combined with AKI (including AKI on chronic kidney disease) and not requiring maintaining renal replacement therapy 3 months after admission. In these 154 patients, 14 were lost to follow up. The remaining 140 patients were staged from 1 to 3 according to AKI criteria based on KDIGO guideline. Short-term recovery was assessed according to the serum creatinine level change, and patients were divided in to 2 groups: ≥30% decline(G1), and ＜30% decline or rise (G1) at 3 month comparing to pre-episode baseline. Long term renal endpoint was defined as: reaching an eGFR level of <15ml/min/1.72m2 or requiring maintaining renal replacement therapy for more than 3 months. Univariate analysis and multivariate analysis were used to compare the outcome.
Results
At admission, 49(35%) were in AKI stage 1, 53(37.0%) in stage 2 and 38(27.1%) were in stage 3. Three months after admission, there were 75 patients in G1, and 65 patients in G2(including 24 patients with rising serum creatine level). No significant differences in age and gender(p>0.05) were found. AKI stage(p<0.001), 24h urine protein(p=0.012) and urine red blood cell per μl(p=0.015) were found associated with short-term recovery. Twenty-three patients reached the renal endpoint during the median follow-up duration of 54(32,79) months. The renal survival rates of AKI stage 1 patients were 91.90% ,79.07 % in stage 2 and 71.80% in stage 3, Kaplan-Meier analysis suggested significant difference (p=0.034). Additionally, renal survival rates were 90.7% in G1 and 75.4% in G2, and Kaplan-Meier analysis showed significant difference between the two groups (p=0.013). The COX model suggested that high AKI stage (OR=5.765, 95%CI 1.886-17.619; p=0.002), high baseline serum creatine (OR=1.008,95%CI 1.001-1.016, P=0.027), and G1(OR=0.084, 95%CI 0.019-0.37) were independent risk factors of renal outcome in patients with ANCA associated vasculitis.
Conclusion
In patients with ANCA associated vasculitis, AKI stage, 24h urine protein and hematuria were associated with short-term outcome; AKI stage, baseline scr, and serum creatinine recovery level at 3 months were independent risk factors of long-term renal outcome.