Karl Emil Nelveg-Kristensen1,2, Wladimir Szpirt1, Nicholas Carlson1, Mark McClure2,3, David Jayne2,3, Hans Dieperink4, Jon Waarst Gregersen5, Elizabeth Krarup6, Per Ivarsen7, Christian Torp-Pedersen8,9, Martin Egfjord1. 1. Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. 2. Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK. 3. Department of Medicine, University of Cambridge, Cambridge, UK. 4. Department of Nephrology, Odense University Hospital, Odense, Denmark. 5. Department of Nephrology, SLE and Vasculitis Clinic, Aalborg University Hospital, Aalborg, Denmark. 6. Department of Nephrology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark. 7. Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark. 8. Department of Cardiology and Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark. 9. Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
Abstract
BACKGROUND: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) carries a high risk of morbidity and mortality, with outcomes modified by treatment and an incidence that may be increasing. We examined temporal changes in incidence and mortality during 2000-15 using nationwide healthcare registries. METHODS: Patients with incident AAV were identified using International Classification of Diseases Version 10 (ICD10) codes and grouped according to inclusion year (Period 1: 2000-04, Period 2: 2005-09, Period 3: 2010-15). Log link cumulative incidence regression adjusted for age, sex, renal function, cardiovascular disease, diabetes, hypertension and advanced disease severity were used to model survival. RESULTS: We identified 1631 patients (52% male), corresponding to an incidence of 18.5 persons/million/year (Period 1: 15.1, Period 2: 18.5, Period 3: 21.4). The slope of incident serologic ANCA testing was steeper than that of AAV (P = 0.002). Mean [standard deviation (SD)] age was 60.2 (16.7) years and mean (SD) follow-up was 6.8 (4.7) years. A total of 571 (35%) patients died (5-year mortality of 22.1%), with an absolute risk ratio (ARR) for Periods 2 and 3 compared with Period 1 of 0.80 [confidence interval (CI) 0.65-0.98, P = 0.031] and 0.39 (CI 0.31-0.50, P < 0.001). About 274 patients developed end-stage renal disease (ESRD) [16.8% (Period 1: 23.3%, Period 2: 17.6%, Period 3: 12.5%)], with ARR decreasing over time: Period 2 0.61 (CI 0.42-0.87, P = 0.007) and Period 3 0.57 (CI 0.39-0.83, P = 0.003). The overall risk of death associated with ESRD or chronic kidney disease was 1.74 (CI 1.29-2.37, P < 0.001) and 1.58 (CI 1.21-2.07, P < 0.001). CONCLUSIONS: Incidence of ANCA testing and AAV diagnosis increased over the test period. Falls over time in mortality and ESRD risk may relate to earlier diagnosis and changes in treatment practice.
BACKGROUND: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) carries a high risk of morbidity and mortality, with outcomes modified by treatment and an incidence that may be increasing. We examined temporal changes in incidence and mortality during 2000-15 using nationwide healthcare registries. METHODS: Patients with incident AAV were identified using International Classification of Diseases Version 10 (ICD10) codes and grouped according to inclusion year (Period 1: 2000-04, Period 2: 2005-09, Period 3: 2010-15). Log link cumulative incidence regression adjusted for age, sex, renal function, cardiovascular disease, diabetes, hypertension and advanced disease severity were used to model survival. RESULTS: We identified 1631 patients (52% male), corresponding to an incidence of 18.5 persons/million/year (Period 1: 15.1, Period 2: 18.5, Period 3: 21.4). The slope of incident serologic ANCA testing was steeper than that of AAV (P = 0.002). Mean [standard deviation (SD)] age was 60.2 (16.7) years and mean (SD) follow-up was 6.8 (4.7) years. A total of 571 (35%) patients died (5-year mortality of 22.1%), with an absolute risk ratio (ARR) for Periods 2 and 3 compared with Period 1 of 0.80 [confidence interval (CI) 0.65-0.98, P = 0.031] and 0.39 (CI 0.31-0.50, P < 0.001). About 274 patients developed end-stage renal disease (ESRD) [16.8% (Period 1: 23.3%, Period 2: 17.6%, Period 3: 12.5%)], with ARR decreasing over time: Period 2 0.61 (CI 0.42-0.87, P = 0.007) and Period 3 0.57 (CI 0.39-0.83, P = 0.003). The overall risk of death associated with ESRD or chronic kidney disease was 1.74 (CI 1.29-2.37, P < 0.001) and 1.58 (CI 1.21-2.07, P < 0.001). CONCLUSIONS: Incidence of ANCA testing and AAV diagnosis increased over the test period. Falls over time in mortality and ESRD risk may relate to earlier diagnosis and changes in treatment practice.
Authors: Rocío Redondo-Rodriguez; Natalia Mena-Vázquez; Alba María Cabezas-Lucena; Sara Manrique-Arija; Arkaitz Mucientes; Antonio Fernández-Nebro Journal: J Clin Med Date: 2022-05-04 Impact factor: 4.964
Authors: Allyson C Egan; Andreas Kronbichler; Irmgard Neumann; Alessandra Bettiol; Nicholas Carlson; Maria C Cid; Giacomo Emmi; Seerapani Gopaluni; Lorraine Harper; Thomas Hauser; Mark A Little; Raashid A Luqmani; Alfred Mahr; Mark McClure; Aladdin J Mohammad; Karl Emil Nelveg-Kristensen; Sophie Ohlsson; Chen Au Peh; Matthew Rutherford; Beatriz Sanchez Alamo; Jennifer Scott; Mårten Segelmark; Rona M Smith; Wladimir M Szpirt; Gunnar Tomasson; Giorgio Trivioli; Augusto Vaglio; Michael Walsh; Maria Wester Trejo; Kerstin Westman; Ingeborg M Bajema; David R W Jayne Journal: Kidney Int Rep Date: 2022-05-25
Authors: Edyta Maria Urbanska; Johanna Elversang; Bonnie Colville-Ebeling; Johan Olof Löfgren; Karl Emil Nelveg-Kristensen; Wladimir M Szpirt Journal: Clin Pract Date: 2021-05-14