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Abstract: SA-PO656

Long-Term Outcomes of Patients with ANCA-Associated Vasculitis (AAV) Presenting with Severe Renal Dysfunction

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Tanna, Anisha, Imperial College Healthcare NHS Trust, London, United Kingdom
  • McAdoo, Stephen Paul, Imperial College Healthcare NHS Trust, London, United Kingdom
  • Kang, Amy, Imperial College Healthcare NHS Trust, London, United Kingdom
  • Gulati, Kavita, Imperial College Healthcare NHS Trust, London, United Kingdom
  • Azam, Sultana, Imperial College Healthcare NHS Trust, London, United Kingdom
  • Levy, Jeremy B., Imperial College Healthcare NHS Trust, London, United Kingdom
  • Griffith, Megan, Imperial College Healthcare NHS Trust, London, United Kingdom
  • Cairns, Tom, Imperial College Healthcare NHS Trust, London, United Kingdom
  • Tam, Frederick W.K., Imperial College Healthcare NHS Trust, London, United Kingdom
  • Pusey, Charles D., Imperial College Healthcare NHS Trust, London, United Kingdom
Background

Rapidly progressive glomerulonephritis (RPGN) is an important cause of morbidity and mortality in AAV. Few studies have specifically addressed the outcome of patients presenting with severe RPGN, traditionally defined as dialysis-dependence or a serum creatinine (SCr) of over 500µmol/l, and in particular the benefit of plasma exchange (PEX). Recent research has challenged the role of PEX in this patient set. Here we describe the long-term patient and renal outcomes in a large cohort of patients with severe RPGN treated with PEX at our centre.

Methods

This is a retrospective analysis of patients treated from 1977-2017 with newly presenting AAV and severe RPGN. Patients were classified as being dialysis-independent with a sCr>500µmol/l or as dialysis-dependent (defined as the need for dialysis within 72 hours of admission). Patients were treated consistently with steroids, cyclophosphamide and plasma exchange (with Rituximab post 2011) and with azathioprine as first line maintenance.

Results

Data were obtained for 181 patients, 149 of whom presented with dialysis-dependence. There were no demographic or treatment differences between the two groups. Patients who were not dialysed at presentation had significantly improved renal and patient survival at 1 and 5 years when compared to patients who presented dialysis dependent (Figure 1).

Conclusion

Renal and patient outcomes were favourable compared to other studies of this patient group. There was a striking difference in outcomes for dialysis-dependent patients when compared to those who had a sCr of >500µmol/l with independent renal function; it may be relevant to analyse patients with severe renal dysfunction according to these criteria in future therapeutic trials.