Age Axi, Huang Ruihong, Li Yinan, Pei Juan
Department of Nephrology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.
Ren Fail. 2025 Dec;47(1):2519818. doi: 10.1080/0886022X.2025.2519818. Epub 2025 Jul 14.
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare disease with high rate of end-stage kidney disease (ESKD) and mortality. We aimed to investigate the risk factors for ESKD and/or death in AAV patients.
Seventy-eight AAV patients diagnosed from November 2013 to December 2022 were included. Study endpoints included ESKD or death and composite endpoints. Cox regression models were used to adjust for potential baseline confounders.
Among the 78 cases, there were 16 cases of ESKD, 15 cases of death, and 27 cases of composite endpoint during follow-up. After adjusting for baseline characteristics, baseline blood urea nitrogen (BUN) level (adjusted hazard ratio [HR] 1.07, 95%Cl 1.04-1.10) was an independent risk factor for composite endpoints (ESKD and/or death) in AAV patients. ROC curve analysis showed that the optimal cutoff of BUN level was 19.5 mmol/L for ESKD and death (AUC: 0.760; 95% CI: 0.65-0.87). Baseline BUN levels (HR per 1 mmol/L: 1.09, 95% CI 1.05-1.23) and white blood cell (WBC) counts (HR per 1,000/μL: 1.22, 95% CI 1.07-1.40) were independent risk factors for ESKD in AAV. Cardiovascular involvement (HR 8.74, 95%Cl 2.20-34.73), NLR (HR 1.04, 95%Cl 1.01-1.08), and antiplatelet drug use (HR 6.79, 95%Cl 1.33-34.62) were independent risk factors for death in AAV.
These findings suggest that high baseline BUN level was an independent predictor for ESKD and/or death in AAV patients, even after correction for co-founders including Scr. BUN might constitute an independent, easily available and important parameter for risk stratification in AAV.
抗中性粒细胞胞浆抗体（ANCA）相关血管炎（AAV）是一种罕见疾病，终末期肾病（ESKD）发生率和死亡率较高。我们旨在研究AAV患者发生ESKD和/或死亡的危险因素。
纳入2013年11月至2022年12月诊断的78例AAV患者。研究终点包括ESKD或死亡以及复合终点。采用Cox回归模型对潜在的基线混杂因素进行校正。
78例患者中，随访期间有16例发生ESKD，15例死亡，27例出现复合终点。校正基线特征后，基线血尿素氮（BUN）水平（校正风险比[HR]1.07，95%置信区间[CI]1.04 - 1.10）是AAV患者复合终点（ESKD和/或死亡）的独立危险因素。ROC曲线分析显示，ESKD和死亡的BUN水平最佳截断值为19.5 mmol/L（曲线下面积[AUC]：0.760；95% CI：0.65 - 0.87）。基线BUN水平（每1 mmol/L的HR：1.09，95% CI 1.05 - 1.23）和白细胞（WBC）计数（每1000/μL的HR：1.22，95% CI 1.07 - 1.40）是AAV患者发生ESKD的独立危险因素。心血管受累（HR 8.74，95% CI 2.20 - 34.73）、中性粒细胞与淋巴细胞比值（NLR）（HR 1.04，95% CI 1.01 - 1.08）以及使用抗血小板药物（HR 6.79，95% CI 1.33 - 34.62）是AAV患者死亡的独立危险因素。
这些发现表明，即使在校正包括血肌酐（Scr）在内的共同因素后，高基线BUN水平仍是AAV患者发生ESKD和/或死亡的独立预测因素。BUN可能构成AAV风险分层中一个独立、易于获得且重要的参数。
