The outcomes of patients with ESRD and ANCA-associated Vasculitis in Australia and New Zealand

Wen Tang, Bhadran Bose, Stephen P. Mcdonald, Carmel M. Hawley, Sunil V. Badve, Neil Boudville, Fiona G. Brown, Philip A. Clayton, Scott B. Campbell, Chen Au Peh, David W. Johnson

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background and objectives this study aimed to evaluate dialysis and transplant outcomes of patients with ESRD secondary to ANCA-associated vasculitis (AAV). Design, setting, participants, & measurements All ESRD patients who commenced renal replacement therapy in Australia and New Zealand between 1996 and 2010 were included. Outcomes were assessed by Kaplan-Meier, multivariable Cox regression, and competing-risks regression survival analyses. Results Of 36,884 ESRD patients, 228 had microscopic polyangiitis (MPA) and 221 had granulomatosis with polyangiitis (GPA). Using competing-risks regression, compared with other causes of ESRD, MPA patients (hazard ratio [HR], 0.89; 95% confidence interval [95% CI], 0.73-1.08; P=0.24) and GPA patients (HR, 0.94; 95% CI, 0.74-1.19; P=0.62) experienced comparable survival on dialysis. Forty-six MPA patients (21%) and 47 GPA (20%) patients received 98 renal allografts. Respective 10-year first graft survival rates in MPA, GPA, and non-AAV patients were 50%, 62%, 70%, whereas patient survival rates were 68%, 85% and 83%, respectively. Compared with non-AAV patients, MPA transplant recipients had higher risks of graft failure (HR, 1.87; 95% CI, 1.07-3.25; P=0.03) and death (HR, 1.94; 95% CI, 1.02-3.69; P=0.04), whereas GPA transplant recipients experienced comparable renal allograft survival (HR, 0.91; 95% CI, 0.43-1.93; P=0.81) and patient survival (HR, 0.58; 95% CI, 0.23-2.27; P=0.58). AAV recurrence was observed in two renal allografts (2%). Conclusions Compared with ESRD patients without AAV, those with GPA have comparable renal replacement therapy outcomes, whereas MPA patients have comparable dialysis survival but poorer renal transplant allograft and patient survival rates.

LanguageEnglish
Pages773-780
Number of pages8
JournalClinical Journal of the American Society of Nephrology
Volume8
Issue number5
DOIs
Publication statusPublished - 7 May 2013
Externally publishedYes

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Tang, Wen ; Bose, Bhadran ; Mcdonald, Stephen P. ; Hawley, Carmel M. ; Badve, Sunil V. ; Boudville, Neil ; Brown, Fiona G. ; Clayton, Philip A. ; Campbell, Scott B. ; Peh, Chen Au ; Johnson, David W. / The outcomes of patients with ESRD and ANCA-associated Vasculitis in Australia and New Zealand. In: Clinical Journal of the American Society of Nephrology. 2013 ; Vol. 8, No. 5. pp. 773-780.
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title = "The outcomes of patients with ESRD and ANCA-associated Vasculitis in Australia and New Zealand",
abstract = "Background and objectives this study aimed to evaluate dialysis and transplant outcomes of patients with ESRD secondary to ANCA-associated vasculitis (AAV). Design, setting, participants, & measurements All ESRD patients who commenced renal replacement therapy in Australia and New Zealand between 1996 and 2010 were included. Outcomes were assessed by Kaplan-Meier, multivariable Cox regression, and competing-risks regression survival analyses. Results Of 36,884 ESRD patients, 228 had microscopic polyangiitis (MPA) and 221 had granulomatosis with polyangiitis (GPA). Using competing-risks regression, compared with other causes of ESRD, MPA patients (hazard ratio [HR], 0.89; 95{\%} confidence interval [95{\%} CI], 0.73-1.08; P=0.24) and GPA patients (HR, 0.94; 95{\%} CI, 0.74-1.19; P=0.62) experienced comparable survival on dialysis. Forty-six MPA patients (21{\%}) and 47 GPA (20{\%}) patients received 98 renal allografts. Respective 10-year first graft survival rates in MPA, GPA, and non-AAV patients were 50{\%}, 62{\%}, 70{\%}, whereas patient survival rates were 68{\%}, 85{\%} and 83{\%}, respectively. Compared with non-AAV patients, MPA transplant recipients had higher risks of graft failure (HR, 1.87; 95{\%} CI, 1.07-3.25; P=0.03) and death (HR, 1.94; 95{\%} CI, 1.02-3.69; P=0.04), whereas GPA transplant recipients experienced comparable renal allograft survival (HR, 0.91; 95{\%} CI, 0.43-1.93; P=0.81) and patient survival (HR, 0.58; 95{\%} CI, 0.23-2.27; P=0.58). AAV recurrence was observed in two renal allografts (2{\%}). Conclusions Compared with ESRD patients without AAV, those with GPA have comparable renal replacement therapy outcomes, whereas MPA patients have comparable dialysis survival but poorer renal transplant allograft and patient survival rates.",
author = "Wen Tang and Bhadran Bose and Mcdonald, {Stephen P.} and Hawley, {Carmel M.} and Badve, {Sunil V.} and Neil Boudville and Brown, {Fiona G.} and Clayton, {Philip A.} and Campbell, {Scott B.} and Peh, {Chen Au} and Johnson, {David W.}",
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Tang, W, Bose, B, Mcdonald, SP, Hawley, CM, Badve, SV, Boudville, N, Brown, FG, Clayton, PA, Campbell, SB, Peh, CA & Johnson, DW 2013, 'The outcomes of patients with ESRD and ANCA-associated Vasculitis in Australia and New Zealand', Clinical Journal of the American Society of Nephrology, vol. 8, no. 5, pp. 773-780. https://doi.org/10.2215/CJN.08770812

The outcomes of patients with ESRD and ANCA-associated Vasculitis in Australia and New Zealand. / Tang, Wen; Bose, Bhadran; Mcdonald, Stephen P.; Hawley, Carmel M.; Badve, Sunil V.; Boudville, Neil; Brown, Fiona G.; Clayton, Philip A.; Campbell, Scott B.; Peh, Chen Au; Johnson, David W.

In: Clinical Journal of the American Society of Nephrology, Vol. 8, No. 5, 07.05.2013, p. 773-780.

Research output: Contribution to journalArticle

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T1 - The outcomes of patients with ESRD and ANCA-associated Vasculitis in Australia and New Zealand

AU - Tang, Wen

AU - Bose, Bhadran

AU - Mcdonald, Stephen P.

AU - Hawley, Carmel M.

AU - Badve, Sunil V.

AU - Boudville, Neil

AU - Brown, Fiona G.

AU - Clayton, Philip A.

AU - Campbell, Scott B.

AU - Peh, Chen Au

AU - Johnson, David W.

PY - 2013/5/7

Y1 - 2013/5/7

N2 - Background and objectives this study aimed to evaluate dialysis and transplant outcomes of patients with ESRD secondary to ANCA-associated vasculitis (AAV). Design, setting, participants, & measurements All ESRD patients who commenced renal replacement therapy in Australia and New Zealand between 1996 and 2010 were included. Outcomes were assessed by Kaplan-Meier, multivariable Cox regression, and competing-risks regression survival analyses. Results Of 36,884 ESRD patients, 228 had microscopic polyangiitis (MPA) and 221 had granulomatosis with polyangiitis (GPA). Using competing-risks regression, compared with other causes of ESRD, MPA patients (hazard ratio [HR], 0.89; 95% confidence interval [95% CI], 0.73-1.08; P=0.24) and GPA patients (HR, 0.94; 95% CI, 0.74-1.19; P=0.62) experienced comparable survival on dialysis. Forty-six MPA patients (21%) and 47 GPA (20%) patients received 98 renal allografts. Respective 10-year first graft survival rates in MPA, GPA, and non-AAV patients were 50%, 62%, 70%, whereas patient survival rates were 68%, 85% and 83%, respectively. Compared with non-AAV patients, MPA transplant recipients had higher risks of graft failure (HR, 1.87; 95% CI, 1.07-3.25; P=0.03) and death (HR, 1.94; 95% CI, 1.02-3.69; P=0.04), whereas GPA transplant recipients experienced comparable renal allograft survival (HR, 0.91; 95% CI, 0.43-1.93; P=0.81) and patient survival (HR, 0.58; 95% CI, 0.23-2.27; P=0.58). AAV recurrence was observed in two renal allografts (2%). Conclusions Compared with ESRD patients without AAV, those with GPA have comparable renal replacement therapy outcomes, whereas MPA patients have comparable dialysis survival but poorer renal transplant allograft and patient survival rates.

AB - Background and objectives this study aimed to evaluate dialysis and transplant outcomes of patients with ESRD secondary to ANCA-associated vasculitis (AAV). Design, setting, participants, & measurements All ESRD patients who commenced renal replacement therapy in Australia and New Zealand between 1996 and 2010 were included. Outcomes were assessed by Kaplan-Meier, multivariable Cox regression, and competing-risks regression survival analyses. Results Of 36,884 ESRD patients, 228 had microscopic polyangiitis (MPA) and 221 had granulomatosis with polyangiitis (GPA). Using competing-risks regression, compared with other causes of ESRD, MPA patients (hazard ratio [HR], 0.89; 95% confidence interval [95% CI], 0.73-1.08; P=0.24) and GPA patients (HR, 0.94; 95% CI, 0.74-1.19; P=0.62) experienced comparable survival on dialysis. Forty-six MPA patients (21%) and 47 GPA (20%) patients received 98 renal allografts. Respective 10-year first graft survival rates in MPA, GPA, and non-AAV patients were 50%, 62%, 70%, whereas patient survival rates were 68%, 85% and 83%, respectively. Compared with non-AAV patients, MPA transplant recipients had higher risks of graft failure (HR, 1.87; 95% CI, 1.07-3.25; P=0.03) and death (HR, 1.94; 95% CI, 1.02-3.69; P=0.04), whereas GPA transplant recipients experienced comparable renal allograft survival (HR, 0.91; 95% CI, 0.43-1.93; P=0.81) and patient survival (HR, 0.58; 95% CI, 0.23-2.27; P=0.58). AAV recurrence was observed in two renal allografts (2%). Conclusions Compared with ESRD patients without AAV, those with GPA have comparable renal replacement therapy outcomes, whereas MPA patients have comparable dialysis survival but poorer renal transplant allograft and patient survival rates.

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T2 - Clinical Journal of the American Society of Nephrology

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