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Kidney Week

Abstract: TH-PO608

Impact of Sex in Clinical Presentation and Outcomes of Patients with ANCA-Associated Vasculitis with Severe Kidney Diseases

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Casal Moura, Marta Isabel Rodrigues, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Patricio-Liébana, Marc, Hospital Universitari Vall d'Hebron, Barcelona, Catalunya, Spain
  • Zubidat, Dalia, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Vargas-Brochero, Maria Jose, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Valencia-Morales, Nancy Daniela, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Machado, Miriam, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Abouzahir, Sana, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Zand, Ladan, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Specks, Ulrich, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Sethi, Sanjeev, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Fervenza, Fernando C., Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Soler, Maria Jose, Hospital Universitari Vall d'Hebron, Barcelona, Catalunya, Spain
Background

The impact of sex in the clinical presentation and outcomes of patients with anti-neutrophil cytoplasmic antibodies (ANCA) associated vasculitis (AAV) with glomerulonephritis (AAV-GN) has not been studied, particularly in patients with severe kidney involvement (eGFR<15mL/min/1.73m2).

Methods

A retrospective cohort study on MPO-or PR3-ANCA patients with AAV (MPA or GPA) and eGFR<15 ml/min/1.73 m2 or ESKD at presentation. Clinical presentation and outcomes were analyzed according with sex.

Results

We analyzed 166 patients with biopsy proven active AAV-GN and eGFR<15mL/min/1.73m2 at diagnosis:78(47%) females and 88(53%) males. Arterial hypertension was more frequent in males (85.2%vs.70.5%,p=0.022). Median serum creatinine (SCr) was higher in males when compared with females (5.2[IQR 4.2-7.4]vs.3.6[IQR 2.8-5.1]mg/dL,p<0.001) but there were no differences in eGFR at presentation (9.9vs.12.1 mL/min/1.73m2,p=0.053).There were no differences between groups in age at diagnosis, GPAvs.MPA, ANCA specificity, frequency of alveolar hemorrhage, BVAS score, chronicity score or crescentic features on kidney biopsy. Males received IV methylprednisolone more frequently (84.1%vs.69.2%,p=0.023),but other therapies were similar.Most patients who started dialysis within 4 weeks were males(53.4%vs.30.8%,p=0.003), however the rate of progression to ESKD at 12 months between groups was similar(p=0.186). When analyzing only the 71 patients that started dialysis within 4 weeks, infections at 12 months were more common in females (75.0%vs.36.2%,p=0.017). Rate of dialysis initiation or progression to ESKD was not different between males(n=61.7%) vs. females (n=62.5%) being on dialysis at 12 months.By multivariable logistic regression,factors related with dialysis initiation within 4 weeks in our cohort were SCr(OR1.478,[95%CI1.231-1.776],p<0.001),alveolar hemorrhage(OR2.726,[95%CI 1.099-6.763],p=0.031) and PR3-ANCA(OR3.155,[95%CI 1.485-6.702],p=0.003) adjusted to sex.

Conclusion

In our cohort,males presented with higher SCr, and dialysis was started within 4 weeks more frequently but outcomes were not different. Females had increased frequency of infections at 12 months.