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Clinical outcomes of ANCA-associated vasculitis in elderly patients

  • Nephrology - Original Paper
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Abstract

Background

Older age is independently associated with mortality in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). We hypothesized that a reduced-dose immunosuppressive treatment would result in similar effectiveness and comparable treatment-related morbidity in elderly patients as the regular dose in younger patients. We also postulated that the higher baseline comorbidities may contribute to the higher mortality of the elderly subjects.

Methods

Ninety-three consecutive patients with AAV between 1998 and 2012 were retrospectively analyzed. Forty-one individuals were defined as “elderly” (age >65 years) and 52 as “younger” (age <65 years). All cause and cardiovascular mortality, death due to vasculitis and infections, and effectiveness of “reduced-dose” immunosuppressive treatment in the elderly group were compared to the effects of “full-dose” treatment in younger individuals.

Results

Mortality in the elderly group was higher (p = 0.007). Cardiovascular death was significantly increased (p = 0.002) in the elderly, but mortality due to vasculitis or infections was comparable. Treatment effectiveness was also similar in elderly and younger patients. At the end of the first follow-up year, 37 % of the elderly and 27 % of the younger patients died (p = 0.22). In univariate Cox regression analyses, being older than 65 year, having cardiovascular disease at baseline, need for dialysis at diagnosis, and lower serum albumin were associated with an increased hazard of mortality.

Conclusions

Delivering reduced dose of immunosuppression for elderly patients was associated with satisfactory outcome and favorable treatment-related complication profile. The higher mortality in the elderly could be attributed mainly to baseline cardiovascular morbidity.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Nephrology Department, Szent Margit Hospital, 132 Bécsi Street, Budapest, 1032, Hungary

    Ágnes Haris, Kálmán Polner, József Arányi, Henrik Braunitzer & István Mucsi

  2. Pathology Department, Szent Margit Hospital, 132 Bécsi Street, Budapest, 1032, Hungary

    Ilona Kaszás

  3. Institute of Behavioral Sciences, Semmelweis University, 4 Nagyvárad tér, Budapest, 1089, Hungary

    István Mucsi

  4. Institute of Pathophysiology, Semmelweis University, 4 Nagyvárad tér, Budapest, 1089, Hungary

    István Mucsi

  5. Division of Nephrology, Department of Medicine, McGill University Health Center, 687 Pine Avenue West, Room R2.37, Montreal, QC, H3A 1A1, Canada

    István Mucsi

Authors
  1. Ágnes Haris
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  2. Kálmán Polner
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  3. József Arányi
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  4. Henrik Braunitzer
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  5. Ilona Kaszás
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  6. István Mucsi
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Correspondence to Ágnes Haris.

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Haris, Á., Polner, K., Arányi, J. et al. Clinical outcomes of ANCA-associated vasculitis in elderly patients. Int Urol Nephrol 46, 1595–1600 (2014). https://doi.org/10.1007/s11255-014-0717-y

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  • DOI: https://doi.org/10.1007/s11255-014-0717-y

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