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Abstract: PO1610

Predicting Outcomes in ANCA-Associated Vasculitis Using a Complete National Cohort

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Mcgovern, Dominic P., The Glasgow Renal and Transplant Unit, Glasgow, United Kingdom
  • Lees, Jennifer S., The Glasgow Renal and Transplant Unit, Glasgow, United Kingdom
  • Geddes, Colin C., The Glasgow Renal and Transplant Unit, Glasgow, United Kingdom
  • Mcquarrie, Emily, The Glasgow Renal and Transplant Unit, Glasgow, United Kingdom
  • Stevens, Kate I., The Glasgow Renal and Transplant Unit, Glasgow, United Kingdom

Group or Team Name

  • The Scottish Renal Biopsy Registry
Background

Outcomes in ANCA vasculitis remain difficult to predict & therapeutic decision-making can be challenging. We aimed to establish if a renal risk score (RRS) could predict outcomes.

Methods

The Scottish Renal Biopsy Registry is a complete national dataset of all biopsies performed in Scotland. Those who had a first renal biopsy between 2014 & 2017 with evidence of ANCA vasculitis were included. Demographic data & outcomes were recorded. RRS was calculated. Each patient was categorised according to % of normal glomeruli, % of tubular atrophy/interstitial fibrosis & eGFR (CKD-EPI) at time of biopsy. Individual scores were summated & patients defined as low, medium or high risk. Cox proportional hazard models were created for survival to ESKD, relapse & death, stratified by risk group.

Results

Two-hundred & forty-six patients with biopsy proven ANCA vasculitis were identified. Fifty percent (n=123), 46% (n=112) & 5% (n=11) were stratified as low, medium & high risk respectively. Fifty-two percent (n=129) were male & mean age at biopsy was 66.7±12.2 years. Mean eGFR was lower in the high-risk category (8.6±6.1 ‘v’ Low risk 45.7±26.0 ml/min/1.73m2, p<0.001) & proteinuria was higher (405 (IQR 170-767) ‘v’ Low risk 81 (IQR 41-155) mg/mmol, p<0.001). Thirty-seven percent (n=91) were PR3 antigen positive. Eighteen (n=7%) patients experienced pulmonary haemorrhage; representation similar across all risk categories.

Those categorised as medium or high risk were more likely to receive plasma exchange & or haemodialysis at presentation (p<0.001) compared with the low risk category. Overall, 16% (n=40) of patients relapsed with a trend to higher risk of relapse in the low risk group (27% of these patients, p=0.05). Thirty seven (15%) patients developed ESKD. Cox proportional hazard model for development of ESKD shows that those in high risk category were more likely to reach ESKD (adj HR 78.4, 95% CI 14-438.4, p<0.001).

Conclusion

A simple RRS, using routinely reported data, in patients with renal biopsy proven ANCA vasculitis can help to predict development of ESKD. It may also be predictive of future relapse in those with a lower RRS. The RRS could inform monitoring & treatment decisions.

A unique strength of this data is that it is based on a complete national dataset making it less susceptible to bias from regional variations in practice.