A new study has identified 4 renal function trajectories in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), with over half of patients affected by renal manifestations. The study, published in Arthritis Care & Research, highlights the burden of chronic kidney disease (CKD) in this patient population.
“Renal manifestations of AAV span a range of severity, including microscopic hematuria and proteinuria, to transient acute kidney injury, to rapidly progressive glomerulonephritis and end-stage renal disease (ESRD),” the authors wrote.
“We aimed to use a large cohort of AAV patients with diverse disease manifestations, followed over time, to assess whether distinct patterns of renal function change could be identified using trajectory analysis, an agnostic approach.”
The research team included 255 patients with AAV treated between 2002 and 2017. Demographic and laboratory data, including serum creatinine levels, Birmingham Vasculitis Activity Score (BVAS)/granulomatosis with polyangiitis score, phenotypes, and estimated glomerular filtration rate, were collected and monitored for up to 10 years.
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Four trajectory groups of renal function were identified in the cohort: rapid decline (8%), impaired (32%), preserved (51%), and recovering (9%). There were differences in renal function between the groups at baseline. More patients in the rapid decline and impaired groups had CKD and comorbidities than in the other groups, and they progressed to ESRD more quickly.
The authors note that given the older age and greater comorbidity burden in the impaired group, it would be useful to assess whether renal biomarkers beyond serum creatinine, such as soluble CD163 or CD25, could help identify patients in which intensified immunosuppression could help prevent or slow the progression of CKD in AAV.
The identification of these renal function trajectories in patients with AAV could be useful for clinical decision-making, and the results of the study highlight the need for tailored, multidisciplinary care with strategies to preserve renal function and slow its progression to ESRD.
Hanberg JS, Cook C, Fu X, Choi HK, Zhang Y, Wallace ZS. Longitudinal patterns of renal function in antineutrophil cytoplasmic antibody–associated vasculitis. Arthritis Care Res (Hoboken). Published online March 1, 2023. doi:10.1002/acr.25100