AAV ON CHRONIC DIALYSIS

ANCA-associated glomerulonephritis (GN) is linked to high relapse rates and dialysis initiation, yet limited research exists on relapse rates and prognosis after transitioning to chronic hemodialysis. This study aimed to evaluate ANCA-associated GN patients on chronic hemodialysis at our facility and explore inter-facility medical cooperation.

Subjects: Thirty patients with ANCA-associated GN who underwent chronic hemodialysis at our hospital from January 1, 2016, to December 31, 2023. The mean age was 76.5 years (range: 48–95), with 9 males and 21 females. All patients had microscopic polyangiitis (MPA) as the dialysis-inducing disease. The ANCA subtype was MPO-ANCA in 29 patients, with 1 having both anti-GBM antibodies and PR3-ANCA, and another having isolated PR3-ANCA.

Methods: This retrospective study analyzed medical collaboration between hospitals for patients on chronic hemodialysis due to ANCA-associated GN at our specialized dialysis facility, focusing on hospitalization causes, immunosuppressive therapy, vasculitis relapse rates, prognosis, and causes of death.

Of the 30 patients, 23 had a history of hospitalization (35 admissions) at our hospital, while 7 had no prior hospitalizations. Twenty-seven patients were referred to our hospital after starting hemodialysis for rapidly progressive GN (RPGN) at a tertiary hospital, and 3 initiated hemodialysis at our facility for RPGN. Of the 35 hospitalizations, most were transfers from tertiary hospitals (24 cases), followed by dialysis clinics (8 cases) and a psychiatric hospital with dialysis facilities (1 case). One transfer each was from a general outpatient clinic and a dialysis outpatient clinic at our hospital.

Referrals to our outpatient department included 3 for chronic dialysis, 2 for vasculitis therapy, and 2 for blood access reconstruction. Of the 35 hospitalizations, 30 (86%) occurred during vasculitis remission, 5 (14%) during active vasculitis, and 10 (29%) were ANCA-positive. All outpatient clinic referrals were during remission, with 1 (14%) being ANCA-positive. Primary reasons for admission included decreased activities of daily living, infections, heart failure, and vascular access surgery. Comorbidities such as hypertension, diabetes, and dementia were prevalent. No patients were on immunosuppressive drugs, but 66% had been using steroids (average 10.8 mg/day) at the time of admission. Relapse occurred in 8 cases (27%), with a total of 10 episodes. There was no significant difference in vasculitis relapse rates before and after dialysis (p-value: 0.1410, Cox regression). Relapse episodes per person-year were 0.088 pre-dialysis and 0.047 post-dialysis. During the observation period, 11 patients (36.7%) died, with a mean age at death of 81.6 years (±7.2). Causes of death included infections (3), heart failure (2), and 1 each from malignancy, myocardial infarction, arrhythmia, and multiple organ failure. Two deaths had unknown causes. No deaths were directly attributed to vasculitis.

Effective medical collaboration, tailored to hospital capabilities, is essential for managing dialysis patients with ANCA-associated GN. Attention should be given to complications such as infections and heart failure, and relapse should be closely monitored. Steroid reduction or discontinuation should be considered when possible. This abstract was previously presented at the 2025 Annual Meeting of the Japanese Society for Dialysis Therapy.