Investigators have identified factors that predict development of advanced chronic kidney disease (CKD) among patients who have anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis with renal involvement, according to a recent study.
The study confirmed that an elevated serum creatinine level or low estimated glomerular filtration rate (eGFR) at baseline identifies patients at increased risk for adverse renal outcomes. It also found that the best predictors for advanced CKD at the end of follow-up were sclerotic class at biopsy and serum creatinine level at baseline, the end of induction, and after 12 months of treatment, Gelsomina Alle, MD, of Hospital Italiano de Buenos Aires in Argentina, and colleagues reported in Rheumatology International.
The authors noted that, to their knowledge, their study “is one of the few studies that assess prognostic factors within the first year of renal disease in ANCA-associated vasculitis.”
The study, which was observational and retrospective, included 60 patients with biopsy-proven ANCA glomerulonephritis who had at least 1 year of follow-up. Of these, 46 (76.7%) were women. Patients had a mean age of 67.8 years at diagnosis and median follow-up duration of 4.2 years. At the end of follow-up, 12 patients (20%) had an eGFR less than 30 mL/min/1.73 m2, which is consistent with advanced CKD.
On univariate analysis, sclerotic class biopsy was significantly associated with 7.2-fold increased odds of advanced CKD at the end of follow-up. “This could be explained by the irreversible character of these lesions, which are not prone to response to treatment, and therefore, recover renal function,” Dr Alle and colleagues explained.
According to receiver operating characteristic curves, the most accurate predictor of advanced CKD diagnosis was serum creatinine at the end of induction and at 12 months, with areas under the curve of 0.93 and 0.94, respectively, according to the investigators. The best cutoff value for serum creatinine at the end of induction was 1.60 mg/dL or higher, which had a sensitivity and specificity of 100% and 75%, respectively. At 12 months, the best cutoff value was 1.71 mg/dL or higher, with a sensitivity and specificity of 90% and 85%, respectively.
The authors noted that their study “highlights the importance of predictors such as serum creatinine or eGFR obtained after the induction phase of treatment, and after 12 months of treatment, emphasizing the importance of early treatment response.”
Alle G, Scolnik M, Scaglioni V, et al. Prognostic factors associated with advanced chronic kidney disease in a cohort of patients with ANCA vasculitis and renal involvement. Rheumatol Int. Published online January 13, 2023. doi:10.1007/s00296-023-05272-y