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

التفاصيل البيبلوغرافية
العنوان: Disease Activity and Adverse Events in Patients with ANCA-Associated Vasculitides Undergoing Long-Term Dialysis
المؤلفون: Thomas Quemeneur, Cécile Couchoud, Xavier Puéchal, Philippe Brunet, Grégoire Couvrat-Desvergnes, Stéphane Burtey, Frédéric Lavainne, Maëlis Kauffmann, Mickaël Bobot, Noémie Jourde-Chiche, Stanislas Faguer, Benjamin Terrier, Thomas Robert, Alexandre Karras
المساهمون: Centre de néphrologie et transplantation rénale [Hôpital de la Conception - APHM], Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Institut Polytechnique de Paris (IP Paris), Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Polyclinique de l’Atlantique, Partenaires INRAE, Centre atlantique, Nantes, Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre National de Référence Maladies Systémiques et Autoimmunes Rares, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ U970)), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Centre hospitalier [Valenciennes, Nord], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Agence de la biomédecine [Saint-Denis la Plaine]
المصدر: Clin J Am Soc Nephrol
Clinical Journal of the American Society of Nephrology
Clinical Journal of the American Society of Nephrology, 2021, 16 (11), pp.1665-1675. ⟨10.2215/CJN.03190321⟩
بيانات النشر: Ovid Technologies (Wolters Kluwer Health), 2021.
سنة النشر: 2021
مصطلحات موضوعية: Male, Epidemiology, medicine.medical_treatment, Microscopic Polyangiitis, Critical Care and Intensive Care Medicine, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Recurrence, Cause of Death, Neoplasms, Medicine, Registries, infections, end stage kidney diseasechronic dialysis, Aged, 80 and over, relapse, immunosuppression, ANCA, Incidence, cardiovascular, Incidence (epidemiology), Remission Induction, Immunosuppression, Middle Aged, Progression-Free Survival, Survival Rate, Editorial, Cardiovascular Diseases, Nephrology, Cohort, Female, France, Microscopic polyangiitis, Vasculitis, Immunosuppressive Agents, medicine.medical_specialty, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis, Antibodies, Antineutrophil Cytoplasmic, Renal Dialysis, Internal medicine, Humans, Renal Insufficiency, Chronic, Dialysis, Aged, Retrospective Studies, Transplantation, business.industry, Granulomatosis with Polyangiitis, Original Articles, medicine.disease, Kidney Transplantation, business, disease activity, Follow-Up Studies
الوصف: International audience; 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
تدمد: 1555-905X
1555-9041
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::e4f9b21de03e7f756879a3dc836182f4
https://doi.org/10.2215/cjn.03190321
حقوق: OPEN
رقم الأكسشن: edsair.doi.dedup.....e4f9b21de03e7f756879a3dc836182f4
قاعدة البيانات: OpenAIRE
الوصف
تدمد:1555905X
15559041