Kidney Week

Abstract: FR-PO0637

Early Initiation of Kidney Replacement Therapy Is Associated with an Increased Risk of Infection-Related Death in ANCA-Associated Vasculitis: A Multicenter Cohort Study (J-CANVAS)

Session Information

• Glomerular Diseases: Clinical, Outcomes, and Therapeutics Research - ANCA/FSGS
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Kondo, Naoya, Department of Nephrology, Kyoto Katsura Hospital, Kyoto, Japan

Naoya Kondo, MD, PhD

• Kida, Takashi, Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

Takashi Kida, MD, PhD, MPH

• Omura, Satoshi, Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

Satoshi Omura, MD, PhD

• Abe, Yoshiyuki, Department of Internal Medicine and Rheumatology, Juntendo University, Bunkyo-Ku, Tokyo, Japan

Yoshiyuki Abe, MD, PhD

• Takizawa, Naoho, Department of Rheumatology, Chubu Rosai Hospital, Nagoya, Aichi, Japan

Naoho Takizawa

• Kukida, Yuji, Department of Rheumatology, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto, Japan

Yuji Kukida, MD, PhD

• Takagi, Hirosuke, Department of Hematology and Rheumatology, Kagoshima University Hospital, Kagoshima, Japan

Hirosuke Takagi, MD

• Azuma, Naoto, Department of Diabetes, Endocrinology and Clinical Immunology, Hyogo Medical University School of Medicine, Nishinomiya, Hyogo, Japan

Naoto Azuma, MD, PhD

• Fukui, Shoichi, Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

Shoichi Fukui

• Kamada, Kazuro, Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan

Kazuro Kamada

• Shimojima, Yasuhiro, Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan

Yasuhiro Shimojima, MD, PhD

• Takata, Tomoaki, Division of Gastroenterology and Nephrology, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan

Tomoaki Takata, MD, PhD

• Moriyama, Mayuko, Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Shimane, Japan

Mayuko Moriyama

• Takatani, Ayuko, Rheumatic Disease Center, Sasebo Chuo Hospital, Sasebo, Japan

Ayuko Takatani

• Miyawaki, Yoshia, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

Yoshia Miyawaki, MD, PhD, MPH

• Shirai, Tsuyoshi, Department of Rheumatology, Tohoku University Hospital, Sendai, Miyagi, Japan

Tsuyoshi Shirai, MD, PhD

• Ito, Takafumi, Division of Nephrology, Department of Internal Medicine, Teikyo University Chiba Medical Center, Ichihara-shi, Chiba Prefecture, Japan

Takafumi Ito, MD, PhD

• Matsumoto, Isao, Department of Rheumatology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan

Isao Matsumoto, MD, PhD

• Takada, Toshihiko, Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR) Fukushima Medical University, Shirakawa, Fukushima, Japan

Toshihiko Takada, MD, PhD

• Yoshimi, Ryusuke, Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan

Ryusuke Yoshimi, MD, PhD, MBA

• Kawahito, Yutaka, Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

Yutaka Kawahito, MD, PhD

• Ito-Ihara, Toshiko, The Clinical and Translational Research Center, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan

Toshiko Ito-Ihara, MD, PhD

• Yajima, Nobuyuki, Division of Rheumatology, Department of Medicine, Showa Medical University School of Medicine, Shinagawa-ku, Tokyo, Japan

Nobuyuki Yajima, MD, PhD, MPH

• Kawaguchi, Takashi, Department of Clinical Assessment, Tokyo University of Pharmacy and Life Sciences, Hachioji, Tokyo, Japan

Takashi Kawaguchi, PhD, RPh

• Miyata, Hitomi, Department of Nephrology, Kyoto Katsura Hospital, Kyoto, Japan

Hitomi Miyata, MD, PhD

Group or Team Name

• Japan Collaborative Registry of ANCA-Associated Vasculitis (J-CANVAS)

Background

Despite advances in treatment, infection-related death remains a major cause of mortality in patients with ANCA-associated vasculitis (AAV). Some patients with AAV require kidney replacement therapy (KRT) and are at higher risk of infection. However, the association between KRT initiation and infection-related death remains unclear. We examined the association between early KRT initiation and infection-related death in AAV.

Methods

We conducted a nationwide retrospective cohort study using the Japan Collaborative Registry of ANCA-associated Vasculitis (J-CANVAS). Patients were newly diagnosed with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) between January 2017 and March 2023. Early initiation of KRT was defined as initiation within 28 days of diagnosis. The primary outcome was infection-related death, assessed after a 28-day landmark. Poisson regression was performed, adjusting for age, sex, BVAS, and serum albumin. Sensitivity analyses included additional adjustment for eGFR and Cox and Fine–Gray models.

Results

A total of 819 patients (MPA, 590; GPA, 229) were included. Among them, 25 (3.1%) required early KRT and 36 (4.4%) died of infection. Infection-related mortality was higher in the early KRT group than in those without early KRT (16.0 vs 1.3 per 100 person-years). Early KRT initiation was significantly associated with infection-related death (IRR 11.88, 95% CI 4.42–31.93), and this association remained consistent in sensitivity analyses. Steroid pulse therapy was more frequent in the KRT group, whereas other immunosuppressive agents were not increased. Relapse rates were similar between groups (approximately 20%).

Conclusion

Early initiation of KRT was associated with a markedly increased risk of infection-related death in AAV, and this association was not fully explained by disease severity. Relapse proportions were similar between groups. These findings highlight the need to optimize treatment strategies, with particular attention to infection risk in patients requiring KRT.

(A) Fine–Gray CIF for infection-related death. (B) Sensitivity analyses.