Clinical Outcomes of ANCA-associated Vasculitis in Elderly Patients

Overview

Journal Int Urol Nephrol

Publisher Springer

Specialty Nephrology

Date 2014 Apr 24

PMID 24756532

Citations 11

Authors

Agnes Haris

Kalman Polner

Jozsef Aranyi

Henrik Braunitzer

Ilona Kaszas

Istvan Mucsi

Affiliations

Soon will be listed here.

Abstract

Background: Older age is independently associated with mortality in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). We hypothesized that a reduced-dose immunosuppressive treatment would result in similar effectiveness and comparable treatment-related morbidity in elderly patients as the regular dose in younger patients. We also postulated that the higher baseline comorbidities may contribute to the higher mortality of the elderly subjects.

Methods: Ninety-three consecutive patients with AAV between 1998 and 2012 were retrospectively analyzed. Forty-one individuals were defined as "elderly" (age >65 years) and 52 as "younger" (age <65 years). All cause and cardiovascular mortality, death due to vasculitis and infections, and effectiveness of "reduced-dose" immunosuppressive treatment in the elderly group were compared to the effects of "full-dose" treatment in younger individuals.

Results: Mortality in the elderly group was higher (p = 0.007). Cardiovascular death was significantly increased (p = 0.002) in the elderly, but mortality due to vasculitis or infections was comparable. Treatment effectiveness was also similar in elderly and younger patients. At the end of the first follow-up year, 37 % of the elderly and 27 % of the younger patients died (p = 0.22). In univariate Cox regression analyses, being older than 65 year, having cardiovascular disease at baseline, need for dialysis at diagnosis, and lower serum albumin were associated with an increased hazard of mortality.

Conclusions: Delivering reduced dose of immunosuppression for elderly patients was associated with satisfactory outcome and favorable treatment-related complication profile. The higher mortality in the elderly could be attributed mainly to baseline cardiovascular morbidity.

Citing Articles

General prognostic models may neglect vulnerable subgroups in ANCA-associated vasculitis.

Russwurm M, Kortus-Goetze B, Maier-Giebing T, Groene H, Hoyer J J Nephrol. 2023; 36(8):2269-2280.

PMID: 37768548 PMC: 10638135. DOI: 10.1007/s40620-023-01726-5.

Outcomes of remission induction therapy for ANCA-associated vasculitis in the elderly.

Aqeel F, Xu L, Salas A, Wen Y, Eid S, Geetha D Clin Rheumatol. 2023; 42(9):2427-2435.

PMID: 37225927 PMC: 11128295. DOI: 10.1007/s10067-023-06644-2.

Impact of Cardiovascular Risk Factors on the Occurrence of Cardiovascular Events in Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitides.

Roubille C, Henriquez S, Mercuzot C, Duflos C, Dunogue B, Briot K J Clin Med. 2021; 10(11).

PMID: 34070514 PMC: 8198638. DOI: 10.3390/jcm10112299.

Interstitial lung disease with myeloperoxidase-antineutrophil cytoplasmic antibody-associated vasculitis in elderly patients.

Yamaguchi K, Yamaguchi A, Itai M, Onuki Y, Shin Y, Uno S Rheumatol Int. 2021; 41(9):1641-1650.

PMID: 34056682 DOI: 10.1007/s00296-021-04891-7.

Clinical and pathological analysis of 101 cases of ANCA-associated vasculitic kidney injury.

Yang S, Liu Y, Xiao Q, Li C, Wang H Int Urol Nephrol. 2021; 53(10):2099-2106.

PMID: 33666803 DOI: 10.1007/s11255-021-02793-y.

References

Hamour S, Salama A . ANCA comes of age-but with caveats. Kidney Int. 2011; 79(7):699-701. DOI: 10.1038/ki.2010.558. View

Chen M, Yu F, Zhang Y, Zhao M . Antineutrophil cytoplasmic autoantibody-associated vasculitis in older patients. Medicine (Baltimore). 2008; 87(4):203-209. DOI: 10.1097/MD.0b013e31817c744b. View

Jennette J, Falk R, Andrassy K, Bacon P, Churg J, Gross W . Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum. 1994; 37(2):187-92. DOI: 10.1002/art.1780370206. View

Little M, Nightingale P, Verburgh C, Hauser T, Groot K, Savage C . Early mortality in systemic vasculitis: relative contribution of adverse events and active vasculitis. Ann Rheum Dis. 2009; 69(6):1036-43. DOI: 10.1136/ard.2009.109389. View

Higgins R, Goldsmith D, Connolly J, Scoble J, Hendry B, Ackrill P . Vasculitis and rapidly progressive glomerulonephritis in the elderly. Postgrad Med J. 1996; 72(843):41-4. PMC: 2398323. DOI: 10.1136/pgmj.72.843.41. View

Levey A, Stevens L, Schmid C, Zhang Y, Castro 3rd A, Feldman H . A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150(9):604-12. PMC: 2763564. DOI: 10.7326/0003-4819-150-9-200905050-00006. View

Walsh M, Flossmann O, Berden A, Westman K, Hoglund P, Stegeman C . Risk factors for relapse of antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Rheum. 2011; 64(2):542-8. DOI: 10.1002/art.33361. View

Harper L, Savage C . ANCA-associated renal vasculitis at the end of the twentieth century--a disease of older patients. Rheumatology (Oxford). 2004; 44(4):495-501. DOI: 10.1093/rheumatology/keh522. View

Harper L, Morgan M, Walsh M, Hoglund P, Westman K, Flossmann O . Pulse versus daily oral cyclophosphamide for induction of remission in ANCA-associated vasculitis: long-term follow-up. Ann Rheum Dis. 2011; 71(6):955-60. DOI: 10.1136/annrheumdis-2011-200477. View

10.

Lane S, Watts R, Shepstone L, Scott D . Primary systemic vasculitis: clinical features and mortality. QJM. 2005; 98(2):97-111. DOI: 10.1093/qjmed/hci015. View

11.

Kaplan-Pavlovcic S, Cerk K, Kveder R, Lindic J, Vizjak A . Clinical prognostic factors of renal outcome in anti-neutrophil cytoplasmic autoantibody (ANCA)-associated glomerulonephritis in elderly patients. Nephrol Dial Transplant. 2003; 18 Suppl 5:v5-7. DOI: 10.1093/ndt/gfg1033. View

12.

Krafcik S, Covin R, Lynch 3rd J, Sitrin R . Wegener's granulomatosis in the elderly. Chest. 1996; 109(2):430-7. DOI: 10.1378/chest.109.2.430. View

13.

Serra A, Romero R . Vasculitides with predominantly renal involvement: influence of age on the mode of presentation. Int Urol Nephrol. 2003; 34(1):151-7. DOI: 10.1023/a:1021349211811. View

14.

Gayraud M, Guillevin L, Le Toumelin P, Cohen P, Lhote F, Casassus P . Long-term followup of polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss syndrome: analysis of four prospective trials including 278 patients. Arthritis Rheum. 2001; 44(3):666-75. DOI: 10.1002/1529-0131(200103)44:3<666::AID-ANR116>3.0.CO;2-A. View

15.

Groot K, Harper L, Jayne D, Flores Suarez L, Gregorini G, Gross W . Pulse versus daily oral cyclophosphamide for induction of remission in antineutrophil cytoplasmic antibody-associated vasculitis: a randomized trial. Ann Intern Med. 2009; 150(10):670-80. DOI: 10.7326/0003-4819-150-10-200905190-00004. View

16.

Hoganson D, From A, Michet C . ANCA vasculitis in the elderly. J Clin Rheumatol. 2008; 14(2):78-81. DOI: 10.1097/RHU.0b013e31816b2fbd. View

17.

Satchell S, Nicholls A, DSouza R, Beaman M . Renal vasculitis: increasingly a disease of the elderly?. Nephron Clin Pract. 2004; 97(4):c142-6. DOI: 10.1159/000079173. View

18.

Bomback A, Appel G, Radhakrishnan J, Shirazian S, Herlitz L, Stokes B . ANCA-associated glomerulonephritis in the very elderly. Kidney Int. 2010; 79(7):757-64. DOI: 10.1038/ki.2010.489. View

19.

Lode H, Schmidt-Ioanas M . Vasculitis and infection: effects of immunosuppressive therapy. Clin Nephrol. 2005; 64(6):475-9. DOI: 10.5414/cnp64475. View

20.

Chen Y, Yu H, Zhang W, Ren H, Chen X, Shen P . Analyzing fatal cases of Chinese patients with primary antineutrophil cytoplasmic antibodies-associated renal vasculitis: a 10-year retrospective study. Kidney Blood Press Res. 2008; 31(5):343-9. DOI: 10.1159/000165117. View