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Kidney Week

Abstract: PO0812

Disease Activity and Adverse Events in Patients with ANCA-Associated Vasculitides Undergoing Long-Term Dialysis: The DIAVAS Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kauffmann, Maelis, Aix-Marseille Universite, Marseille, Provence-Alpes-Côte d'Azu, France
  • Couchoud, Cécile, Agence de la biomedecine, La Plaine Saint-Denis, France
  • Jourde-Chiche, Noemie, Aix-Marseille Universite, Marseille, Provence-Alpes-Côte d'Azu, France

Group or Team Name

  • French Vasculitis Study Group and REIN registry
Background

Kidney impairment of ANCA-associated vasculitides can lead to kidney failure. Patients with kidney failure may suffer from vasculitis relapses, but are also at high risk of infections and cardiovascular events, which questions the maintenance of immunosuppressive therapy.

Methods

Patients with ANCA-associated vasculitides initiating long-term dialysis between 2008-2012 in France, registered in the national REIN registry, and paired with the National Health System database, were included. We analyzed the proportion of patients in remission off-immunosuppression over time, and overall and event-free survival on dialysis (censoring for kidney transplantation). We compared the incidence of vasculitis relapses, serious infections, cardiovascular events and cancers before and after dialysis initiation.

Results

229 patients were included: 142 with granulomatous polyangiitis (GPA) and 87 with microscopic polyangiitis (MPA); 82 patients received a kidney transplant. Mean follow-up after dialysis initiation was 4.6 ± 2.7 years. The proportion of patients in remission off-immunosuppression increased from 23% at dialysis initiation to 62% after 5 years. Overall survival rates on dialysis were 86%, 66% and 54% at 1, 3 and 5 years, respectively. Main causes of death were infections (35%) and cardiovascular events (26%), not vasculitis flares (6%). The incidence of vasculitis flares decreased from 111 to 7 episodes/100 person-year before and after dialysis initiation (p<0.05). Overall, during follow-up, 53% of patients experienced a serious infection, 52% a cardiovascular event, while 17% experienced a vasculitis relapse.

Conclusion

The proportion of patients with ANCA-associated vasculitis in remission off-immunosuppression increases with time spent on dialysis. In this cohort, patients were far less likely to relapse from their vasculitis than to display serious infectious or cardiovascular events. Therefore, the benefit/risk balance of maintenance immunosuppressive therapies in patients on long-term dialysis should be carefully evaluated.