PROGNOSTIC IMPACT OF SEVERE KIDNEY IMPAIRMENT AT TREATMENT INITIATION IN PATIENTS WITH ANTINEUTROPHIL CYTOPLASMIC ANTIBODY-ASSOCIATED VASCULITIS

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Abstract Title *

PROGNOSTIC IMPACT OF SEVERE KIDNEY IMPAIRMENT AT TREATMENT INITIATION IN PATIENTS WITH ANTINEUTROPHIL CYTOPLASMIC ANTIBODY-ASSOCIATED VASCULITIS

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Co-author 1

Akihito Tanaka tanaka.akihito.y5@f.mail.nagoya-u.ac.jp Nagoya University Hospital Nephrology Nagoya Japan *

Co-author 2

Chikao Onogi onogi.chikao.d7@a.mail.nagoya-u.ac.jp Nagoya University Nephrology Nagoya Japan -

Co-author 3

kazuhiro Furuhashi furuhashi.kazuhiro.z0@f.mail.nagoya-u.ac.jp Nagoya University Hospital Nephrology Nagoya Japan -

Co-author 4

Yu Watanabe watanabe.yu.s9@f.mail.nagoya-u.ac.jp Nagoya University Nephrology Nagoya Japan -

Co-author 5

Eri Koshi‑Ito ito.eri.r5@f.mail.nagoya-u.ac.jp Nagoya University Nephrology Nagoya Japan -

Co-author 6

Shoichi Maruyama maruyama.shoichi.y5@f.mail.nagoya-u.ac.jp Nagoya University Nephrology Nagoya Japan -

Co-author 7

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) often affects elderly individuals, in whom excessive immunosuppression has been shown to worsen prognosis. Consequently, treatment strategies have shifted toward avoiding excessive immunosuppression. In recent years, various new therapeutic agents have become available, expanding treatment options for AAV. However, despite these advances, the overall improvement in patient outcomes has plateaued. Previously, we reported that patients who showed severe kidney impairment within the first two weeks of treatment had poorer long-term prognosis, suggesting that early identification and intensive management of such patients might improve prognosis. Because that study was limited by a small sample size, we aimed to verify these findings using a large-scale clinical database.

Methods

This is a noninterventional, population-based cohort study using a large-scale medical claims database. This study included patients with chronic kidney disease (CKD) encompassing various kidney diseases. From this database, we extracted patients with AAV. Data from October 2013 through August 2021 were used. Patients with severe kidney impairment at the start of treatment were defined as those who underwent hemodialysis (HD) within two weeks of receiving an AAV diagnosis. We compared survival outcomes between patients with severe kidney impairment and those without. Observation period was 2 years.

Results

Among 924,238 patients with CKD, patients with HD (n=356) and without HD (n=4,798) were eligible. The mean age was 71±11 years in patients with HD and 73±13 years in patients without HD. The proportion of women was 40% among patients with HD and 47% in patients without HD. The hazard ratio for mortality in HD patients was 1.85 [95% confidence interval 1.38-2.47] before adjustment and 1.74 [1.29-2.36] after adjustment. Subsequent treatments used in patients with HD included cyclophosphamide (1.4%), rituximab (0.8%), and plasma exchange (1.4%).

Conclusion

Patients with AAV presenting severe kidney impairment at onset have a poor prognosis, necessitating new therapeutic strategies.

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