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Original ArticlesMaintenance Dialysis
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Disease Activity and Adverse Events in Patients with ANCA-Associated Vasculitides Undergoing Long-Term Dialysis

Maëlis Kauffmann, Mickaël Bobot, Thomas Robert, Stéphane Burtey, Grégoire Couvrat-Desvergnes, Frédéric Lavainne, Xavier Puéchal, Benjamin Terrier, Thomas Quéméneur, Stanislas Faguer, Alexandre Karras, Philippe Brunet, Cécile Couchoud and Noémie Jourde-Chiche; on behalf of the REIN registry and the French Vasculitis Study Group
CJASN November 2021, 16 (11) 1665-1675; DOI: https://doi.org/10.2215/CJN.03190321
Maëlis Kauffmann
1Assistance Publique-Hôpitaux de Marseille, University hospital de la Conception, Department of Nephrology, Marseille, France
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Mickaël Bobot
1Assistance Publique-Hôpitaux de Marseille, University hospital de la Conception, Department of Nephrology, Marseille, France
2Aix-Marseille Univ, Center for Cardio-Vascular and Nutrition research, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Marseille, France
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Thomas Robert
1Assistance Publique-Hôpitaux de Marseille, University hospital de la Conception, Department of Nephrology, Marseille, France
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Stéphane Burtey
1Assistance Publique-Hôpitaux de Marseille, University hospital de la Conception, Department of Nephrology, Marseille, France
2Aix-Marseille Univ, Center for Cardio-Vascular and Nutrition research, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Marseille, France
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Grégoire Couvrat-Desvergnes
3Hospital La Roche sur Yon–Vendée, Department of Nephrology, La Roche sur Yon, France
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Frédéric Lavainne
4University hospital de Nantes, Department of Nephrology and Clinical Immunology, Nantes, France
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Xavier Puéchal
5Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Department of Internal Medicine, Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Paris, France
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Benjamin Terrier
5Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Department of Internal Medicine, Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Paris, France
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Thomas Quéméneur
6Hospital de Valenciennes, Department of Internal Medicine, Valenciennes, France
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Stanislas Faguer
7University hospital de Toulouse, Hôpital Rangueil, Department of Nephrology and Organ Transplantation, Centre de référence des maladies rénales rares, Institut National de la Santé et de la Recherche Médicale, Institut des Maladies Métaboliques et Cardiovasculaires, Toulouse, France
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Alexandre Karras
8Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Nephrology, Paris, France
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Philippe Brunet
1Assistance Publique-Hôpitaux de Marseille, University hospital de la Conception, Department of Nephrology, Marseille, France
2Aix-Marseille Univ, Center for Cardio-Vascular and Nutrition research, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Marseille, France
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Cécile Couchoud
9Agence de la Biomédecine, Registre Renal Epidemiology and Information Network, Saint-Denis, France
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Noémie Jourde-Chiche
1Assistance Publique-Hôpitaux de Marseille, University hospital de la Conception, Department of Nephrology, Marseille, France
2Aix-Marseille Univ, Center for Cardio-Vascular and Nutrition research, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Marseille, France
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Abstract

Background and objectives 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.

Design, setting, participants, & measurements Patients with ANCA-associated vasculitides initiating long-term dialysis between 2008 and 2012 in France registered in the national Renal Epidemiology and Information Network 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 (considering transplantation as a competing risk). We compared the incidence of vasculitis relapses, serious infections, cardiovascular events, and cancers before and after dialysis initiation.

Results In total, 229 patients were included: 142 with granulomatous polyangiitis and 87 with microscopic polyangiitis. Mean follow-up after dialysis initiation was 4.6±2.7 years; 82 patients received a kidney transplant. 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%, 69%, and 62% at 1, 3, and 5 years, respectively. Main causes of death were infections (35%) and cardiovascular events (26%) but not vasculitis flares (6%). The incidence of vasculitis relapses decreased from 57 to seven episodes per 100 person-years before and after dialysis initiation (P=0.05). Overall, during follow-up, 45% of patients experienced a serious infection and 45% had a cardiovascular event, whereas 13% experienced a vasculitis relapse.

Conclusions 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.

Podcast This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_11_08_CJN03190321.mp3

  • ANCA
  • end stage kidney disease
  • chronic dialysis
  • cardiovascular
  • immunosuppression
  • disease activity
  • relapse
  • infections
  • Received March 2, 2021.
  • Accepted September 8, 2021.
  • Copyright © 2021 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 16 (11)
Clinical Journal of the American Society of Nephrology
Vol. 16, Issue 11
November 2021
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Disease Activity and Adverse Events in Patients with ANCA-Associated Vasculitides Undergoing Long-Term Dialysis
Maëlis Kauffmann, Mickaël Bobot, Thomas Robert, Stéphane Burtey, Grégoire Couvrat-Desvergnes, Frédéric Lavainne, Xavier Puéchal, Benjamin Terrier, Thomas Quéméneur, Stanislas Faguer, Alexandre Karras, Philippe Brunet, Cécile Couchoud, Noémie Jourde-Chiche
CJASN Nov 2021, 16 (11) 1665-1675; DOI: 10.2215/CJN.03190321

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Disease Activity and Adverse Events in Patients with ANCA-Associated Vasculitides Undergoing Long-Term Dialysis
Maëlis Kauffmann, Mickaël Bobot, Thomas Robert, Stéphane Burtey, Grégoire Couvrat-Desvergnes, Frédéric Lavainne, Xavier Puéchal, Benjamin Terrier, Thomas Quéméneur, Stanislas Faguer, Alexandre Karras, Philippe Brunet, Cécile Couchoud, Noémie Jourde-Chiche
CJASN Nov 2021, 16 (11) 1665-1675; DOI: 10.2215/CJN.03190321
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