de Berny Quentin, Diouf Momar, Mesbah Rafik, Quemeneur Thomas, Lebas Céline, Guerrot Dominique, Hachulla Eric, Gibier Jean-Baptiste, Cordonnier Carole, Francois Arnaud, Gueutin Victor, Choukroun Gabriel, Titeca-Beauport Dimitri
Department of Nephrology Dialysis Transplantation, Amiens University Hospital, Amiens, France.
Clinical Research and Innovation Department, Amiens University Hospital, Amiens, France.
Clin Kidney J. 2024 Apr 29;17(8):sfae135. doi: 10.1093/ckj/sfae135. eCollection 2024 Aug.
The anti-neutrophil cytoplasmic antibody (ANCA) renal risk score (ARRS) for predicting renal survival in ANCA-associated vasculitis (AAV) had not previously been validated in adults over 65 years of age and presenting impairments associated with an aging kidney, a high cardiovascular comorbidity burden and prevalent microscopic polyangiitis.
We retrospectively studied a cohort of 192 patients over 65 years of age [median (interquartile range) age: 73 (68-78) years], including 17.2% with renal-limited vasculitis, 49.5% with microscopic polyangiitis and 33.3% with granulomatosis with polyangiitis, at six centres in northern France. The primary study endpoint was the cumulative incidence of end-stage kidney disease (ESKD, maintenance of dialysis for at least 3 months) at 12 months, with death considered as a competing event.
The median serum creatinine concentration at diagnosis was 300 (202-502) µmol/L, and 48 (25.0%) patients required dialysis at presentation. The ARRS was high in 43 (22.4%) patients, medium in 106 (55.2%) and low in 43 (22.4%). The cumulative incidence of ESKD at 12 months was 0% in the low-risk group, 13.0% (interquartile range 7.6-20.0) in the medium-risk group and 44.0% (29.0-58.0) in the high-risk group (.001). In the subgroup of 149 patients presenting a medium or high score, the ARRS had a C-index of 0.66 (0.58-0.74) for the prediction of ESKD at 12 months; this rose to 0.86 (0.80-0.90) when dialysis status at diagnosis was included.
The ARRS was a poor predictor of kidney survival at 12 months among patients over 65 years of age with renal AAV involvement-especially in the high ARRS group. The addition of dialysis status at diagnosis as an additional clinical parameter might improve the predictive performance of the ARRS.
用于预测抗中性粒细胞胞浆抗体（ANCA）相关血管炎（AAV）患者肾脏存活情况的ANCA肾脏风险评分（ARRS），此前尚未在65岁以上、存在与老年肾脏相关损伤、心血管合并症负担高且显微镜下多血管炎普遍存在的成年人中得到验证。
我们对法国北部六个中心的192名6岁以上患者（年龄中位数[四分位间距]：73[68 - 78]岁）进行了回顾性研究，其中17.2%为肾脏局限性血管炎患者，49.5%为显微镜下多血管炎患者，33.3%为肉芽肿性多血管炎患者。主要研究终点是12个月时终末期肾病（ESKD，维持透析至少3个月）的累积发生率，死亡被视为竞争事件。
诊断时血清肌酐浓度中位数为300（202 - 502）µmol/L，48名（25.0%）患者就诊时需要透析。43名（22.4%）患者ARRS高，106名（55.2%）患者ARRS中等，43名（22.4%）患者ARRS低。低风险组12个月时ESKD累积发生率为0%，中风险组为13.0%（四分位间距7.6 - 20.0），高风险组为44.0%（29.0 - 58.0）（P < 0.001）。在149名中高评分患者亚组中，ARRS对12个月时ESKD预测的C指数为0.66（0.58 - 0.74）；纳入诊断时透析状态后，该指数升至0.86（0.80 - 0.90）。
对于65岁以上有肾脏AAV受累的患者，ARRS在预测12个月时肾脏存活情况方面表现不佳——尤其是在ARRS高的组中。将诊断时的透析状态作为一个额外的临床参数可能会提高ARRS的预测性能。
