title: Outcome and treatment of elderly patients with ANCA-associated vasculitis.
abstract: OBJECTIVE
  ANCA-associated vasculitis is commonly found in elderly patients, but there are few data concerning outcome and treatment in the highest age groups.
  
  
  METHODS
  Consecutive patients (N=151) presenting between 1997 and 2009 were retrospectively included from local registries in six centers in Sweden, the United Kingdom, and the Czech Republic if diagnosed with microscopic polyangiitis or granulomatosis with polyangiitis at age ≥75 years during the study period. Patients were followed until 2 years from diagnosis or death. Data on survival and renal function were analyzed with respect to age, sex, ANCA specificity, renal function, C-reactive protein, comorbidities, and Birmingham Vasculitis Activity Score at diagnosis as well as treatment during the first month.
  
  
  RESULTS
  Median follow-up was 730 days (interquartile range, 244-730). Overall 1-year survival was 71.5% and 2-year survival was 64.6%. Older age, higher creatinine, and lower Birmingham Vasculitis Activity Score were associated with higher mortality in multivariable analysis. Patients who were not treated with standard immunosuppressive therapy had significantly worse survival. Renal survival was 74.8% at 1 year. No new cases of ESRD occurred during the second year. High creatinine at diagnosis was the only significant predictor of renal survival in multivariable analysis.
  
  
  CONCLUSIONS
  ANCA-associated vasculitis is a disease with substantial mortality and morbidity among elderly patients. This study showed a better prognosis for those who received immunosuppressive treatment and those who were diagnosed before having developed advanced renal insufficiency.
authors.affiliation: Departments of Nephrology and Medical and Health Sciences and maria.weiner@liu.se.
authors.forename: Maria
authors.initials: M
authors.lastname: Weiner
authors.affiliation: University College London Centre for Nephrology, Royal Free Hospital, London, United Kingdom;
authors.forename: Su Mein
authors.initials: SM
authors.lastname: Goh
authors.affiliation: Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, United Kingdom;
authors.forename: Aladdin J
authors.initials: AJ
authors.lastname: Mohammad
authors.affiliation: Department of Nephrology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic;
authors.forename: Zdenka
authors.initials: Z
authors.lastname: Hruskova
authors.affiliation: Department of Medicine, Imperial College London, London, United Kingdom;
authors.forename: Anisha
authors.initials: A
authors.lastname: Tanna
authors.affiliation: Department of Renal Medicine, Karolinska University Hospital, and Department of Clinical Sciences, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden; and.
authors.forename: Annette
authors.initials: A
authors.lastname: Bruchfeld
authors.affiliation: Department of Nephrology, Lund University, Skåne University Hospital, Lund and Malmö, Sweden.
authors.forename: Daina
authors.initials: D
authors.lastname: Selga
authors.affiliation: Department of Nephrology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic;
authors.forename: Zdenka
authors.initials: Z
authors.lastname: Chocova
authors.affiliation: Department of Nephrology, Lund University, Skåne University Hospital, Lund and Malmö, Sweden.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Westman
authors.affiliation: Rheumatology and Clinical and Experimental Medicine, Linköping University, Linköping, Sweden;
authors.forename: Per
authors.initials: P
authors.lastname: Eriksson
authors.affiliation: Department of Medicine, Imperial College London, London, United Kingdom;
authors.forename: Charles D
authors.initials: CD
authors.lastname: Pusey
authors.affiliation: Department of Nephrology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic;
authors.forename: Vladimir
authors.initials: V
authors.lastname: Tesar
authors.affiliation: University College London Centre for Nephrology, Royal Free Hospital, London, United Kingdom;
authors.forename: Alan D
authors.initials: AD
authors.lastname: Salama
authors.affiliation: Departments of Nephrology and Medical and Health Sciences and.
authors.forename: Mårten
authors.initials: M
authors.lastname: Segelmark
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D018450:Disease Progression; D005060:Europe; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000209:etiology; D008297:Male; D055953:Microscopic Polyangiitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: ANCA; GN; survival; vasculitis