Association Between Any Circulating ANCA Positivity at Diagnosis and Subsequent End-Stage Kidney Disease in Microscopic Polyangiitis and Granulomatosis with Polyangiitis

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Background and Objectives: This study examined whether positivity for any antineutrophil cytoplasmic antibody (ANCA) at diagnosis was associated with subsequent advanced systemic complications during follow-up in patients with microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA). Materials and Methods: We retrospectively reviewed the medical records of 271 patients with MPA or GPA enrolled in the ANCA-associated vasculitis cohort at a tertiary hospital. Any ANCA positivity was defined as the presence of any of the following: myeloperoxidase-ANCA, proteinase 3-ANCA, perinuclear ANCA, or cytoplasmic ANCA. Subsequent advanced systemic complications during follow-up, such as all-cause mortality and end-stage kidney disease (ESKD), were evaluated. Results: The median age of the 271 patients with MPA or GPA was 62.0 years, and 239 and 32 were identified as ANCA-positive and ANCA-negative vasculitis, respectively. During follow-up, 47 patients (17.3%) died, and 52 (19.2%) progressed to ESKD. In a cross-sectional comparative analysis, ESKD occurred significantly more frequently in ANCA-positive patients than in ANCA-negative patients. Among the five subsequent advanced systemic complications of MPA and GPA, ANCA-negative patients exhibited a significantly higher cumulative ESKD-free survival rate than ANCA-positive patients. However, in multivariable Cox proportional hazards analysis adjusted for age, sex, AAV subtype, and baseline serum creatinine, ANCA positivity was not independently associated with subsequent ESKD. Conclusions: Any ANCA positivity at diagnosis was associated with subsequent ESKD in unadjusted analyses but was not an independent predictor after adjustment for baseline renal function and other clinically relevant covariates.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.