title: Older patients with ANCA-associated vasculitis and dialysis dependent renal failure: a retrospective study.
abstract: BACKGROUND
  ANCA-associated vasculitis (AAV) with renal involvement is not uncommon in older individuals. Unfortunately, this can be catastrophic requiring hemodialysis (HD) and may lead to end stage renal disease (ESRD). However, more than 50 % of patients with AAV who require HD initially have renal recovery and discontinue HD. The aim of this study was to describe a retrospective cohort of older patients with AAV and severe renal involvement which required hemodialysis.
  
  
  METHODS
  Between 1995 and 2013 a total of 30 patients with histologic evidence of pauci-immune glomerulonephritis who required HD were evaluated at a single university center. The association of demographic and clinical parameters with age was assessed. Older age of disease onset was defined as age ≥ 60 years. The risk of developing ESRD at 3 months was examined using univariate logistic regression analysis.
  
  
  RESULTS
  Among 30 patients with AAV who required HD, the mean age of disease onset was 59 ± 17 years (range 22-88 years). Twelve patients were in the older age group, and 18 were in the younger group. Three months after diagnosis, 43 % of the cohort had ESRD with a statistically similar proportion of older (n = 9, 50 %) versus younger (n = 4, 33 %) patients (p = 0.367). Most patients (93 %) received immunosuppressive therapy. There was not a statistically significant association between age and ESRD.
  
  
  CONCLUSIONS
  These data suggest that age alone does not predict renal recovery among individuals on HD due to AAV. Renal recovery is a realistic expectation and outcome, if patients are treated, even among older patients with AAV who require HD initially.
authors.affiliation: Division of Rheumatology, Johns Hopkins Vasculitis Center, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Room 1B.13, 21224, Baltimore, MD, USA. rmanno3@jhmi.edu.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Manno
authors.affiliation: Division of Rheumatology, Johns Hopkins Vasculitis Center, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Room 1B.13, 21224, Baltimore, MD, USA. seo@jhmi.edu.
authors.forename: Philip
authors.initials: P
authors.lastname: Seo
authors.affiliation: Division of Nephrology, Johns Hopkins Vasculitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA. gduvura@jhmi.edu.
authors.forename: Duvuru
authors.initials: D
authors.lastname: Geetha
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D003520:Cyclophosphamide / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D005921:Glomerulonephritis / Q000209:etiology* / Q000628:therapy*; D014890:Granulomatosis with Polyangiitis / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000209:etiology*; D008297:Male; D055953:Microscopic Polyangiitis / Q000150:complications* / Q000188:drug therapy; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D006435:Renal Dialysis; D012189:Retrospective Studies; D000069283:Rituximab / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D000069283:Rituximab; D003520:Cyclophosphamide; D009173:Mycophenolic Acid