title: A retrospective study on the outcomes of MPO-ANCA-associated vasculitis in dialysis-dependent patients.
abstract: OBJECTIVE
  This study investigated the clinical course of myeloperoxidase-antineutrophil cytoplasm autoantibody (MPO-ANCA)-associated vasculitis after starting dialysis.
  
  
  METHODS
  A retrospective review was conducted of the clinical charts of dialysis-dependent patients with MPO-ANCA-associated vasculitis who attended one of 8 associated clinics over the past 21 years.
  
  
  RESULTS
  Eighty-nine patients were included in the study; 88 had microscopic polyangiitis (MPA) and 1 had granulomatosis with polyangiitis. Of the 88 patients with MPA, 18 had renal-limited vasculitis. Twenty-one relapses occurred among 13 patients (frequency, 0.05 relapses/person-year; 95% confidence interval, 0.03-0.08). Mean time from start of dialysis to relapse was 65 ± 59 months. Cox multivariate analysis showed that pulmonary involvement was a predictor of relapse (hazard ratio [HR], 21.4) and mortality (HR, 4.60), and that patient age (HR, 1.10) and cyclophosphamide use (HR, 0.20) were significant predictors of mortality. Postdialysis 1- and 5-year survival rates were 83.0% and 65.6%, respectively; infection was the most frequent cause of death.
  
  
  CONCLUSIONS
  Pulmonary involvement was a predictor of relapse and mortality. Although relapse can occur long after the start of dialysis, incidence was low among dialysis-dependent patients. Prolonged maintenance immunosuppressive therapy might be limited to patients with pulmonary involvement in dialysis-dependent ANCA-associated vasculitis.
authors.affiliation: a Department of Nephrology , Fujita Health University School of Medicine , Toyoake, Aichi , Japan.
authors.forename: Midori
authors.initials: M
authors.lastname: Hasegawa
authors.affiliation: a Department of Nephrology , Fujita Health University School of Medicine , Toyoake, Aichi , Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Hattori
authors.affiliation: b Kanayama Clinic , Nagoya, Aichi , Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Sugiyama
authors.affiliation: c Okazaki City Hospital , Okazaki, Aichi , Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Asada
authors.affiliation: d Toyota Memorial Hospital , Toyota, Aichi , Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamashita
authors.affiliation: a Department of Nephrology , Fujita Health University School of Medicine , Toyoake, Aichi , Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: a Department of Nephrology , Fujita Health University School of Medicine , Toyoake, Aichi , Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hayashi
authors.affiliation: a Department of Nephrology , Fujita Health University School of Medicine , Toyoake, Aichi , Japan.
authors.forename: Shigehisa
authors.initials: S
authors.lastname: Koide
authors.affiliation: a Department of Nephrology , Fujita Health University School of Medicine , Toyoake, Aichi , Japan.
authors.forename: Waichi
authors.initials: W
authors.lastname: Sato
authors.affiliation: a Department of Nephrology , Fujita Health University School of Medicine , Toyoake, Aichi , Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Yuzawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000276:immunology*; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009195:Peroxidase / Q000276:immunology*; D012008:Recurrence; D006435:Renal Dialysis; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D009195:Peroxidase
keywords: ANCA-associated vasculitis; Dialysis; Relapse