Kidney failure in patients with ANCA-associated vasculitis: A systematic review of outcomes

Kidney involvement in antineutrophil cytoplasmic antibody-associated vasculitis (AAV) significantly increases morbidity and risk of mortality, particularly with progression to end-stage kidney disease (ESKD). This review focused on the cumulative incidence of ESKD in patients with AAV and assessed how changes in estimated glomerular filtration rate (eGFR) impact the risk of developing ESKD.

Literature searches were performed in the PubMed, EMBASE and Cochrane Library databases, focusing on studies published in 2019-2024 with at least 100 participants and a minimum follow-up of 3 years. Combined estimates of the cumulative incidence of ESKD and hazard ratios (HRs) quantifying the relationship between eGFR and ESKD risk were calculated.

A total of 49 studies (19,301 patients) reported the incidence of ESKD, while 19 studies (4513 patients) reported the relationship between eGFR and ESKD risk. ESKD incidence ranged from 2.9 to 59.6% at 1 year of follow-up, and from 9.4 to 51.4% at 10 years. The meta-analysis found that ESKD incidence was 14.2% and 24.8% at 1 and 10 years of follow-up, respectively, and that 1 mL/min/1.73 m² higher eGFR at diagnosis and at 6 months after diagnosis were associated with 5-6% and 7-8% reductions in ESKD risk, respectively.

This review indicates that patients with AAV remain at high risk of ESKD, with lower eGFR at diagnosis and at 6 months after diagnosis associated with poorer kidney outcomes. However, the pooled estimates should be used with caution, given the high heterogeneity in patient characteristics across studies.