The following is a summary of “Outcomes in ANCA-associated vasculitis patients with end-stage kidney disease on renal replacement therapy—A meta-analysis,” published in the June 2023 issue of the Seminars in Arthritis and Rheumatism by Pope et al.

Patients with anti-neutrophilic cytoplasmic antibody (ANCA)-associated vasculitis (AAV) have a poor prognosis if they have end-stage kidney disease (ESKD). This study examines the outcomes of AAV patients with ESKD who are receiving renal replacement therapy. The MEDLINE and Embase databases were searched from their inception until December 2021. Any study reporting ESKD outcomes in AAV patients on hemodialysis or peritoneal dialysis was included. 

The primary outcome was the mortality rate per 100 person-years (100 py) calculated using a random-effects meta-analysis model. Infection and relapse rates were secondary outcomes. 22 studies of 952 adult patients with over 3,600 person-years of follow-up were included from 2,470 citations. The pooled mortality rate was 10.90 per 100 person-years (95% CI: 7.11 – 14.68; I² = 90.8%). The pooled 1-year survival rate was 80.9% (95% CI: 75.6 – 86.1%, I² = 86.1%), and the pooled 5-year survival rate was 61.0% (95% CI: 46.0 – 76.0%, I² = 0%). The pooled severe infection rate was 66.57 per 100 person-years (95% CI: 13.64±19.50; I² = 99.6%). 

The pooled relapse rate was 6.22 per 100 years (95% CI: 4.64 – 7.80; I2 = 46.6%). Only one pediatric study met the inclusion criteria and reported a mortality rate of 11.7 ±1.9 deaths per 100 person-years (95% CI: 0.23 – 23.20) among 9 patients. AAV and ESKD patients have a lower risk of relapse but higher infection and mortality rates. More prospective research is required to investigate the function of immunosuppression after ESKD.

Source: sciencedirect.com/science/article/abs/pii/S004901722300029X