In the Journals

Mortality from end-stage renal disease declines for granulomatosis with polyangiitis

Zachary S. Wallace

Researchers reported significant declines in the mortality rates of patients diagnosed with end-stage renal disease caused by granulomatosis with polyangiitis during the past 2 decades, which is likely due to improved management of such patients.

“While long-term survival has improved over the last two decades among patients with [granulomatosis with polyangiitis (GPA)], we did not know temporal trends in survival among patients with [end-stage renal disease (ESRD)] due to GPA,” Zachary S. Wallace, MD, of Massachusetts General Hospital, in Boston, told Healio Rheumatology. “In this study, we found that survival for this subgroup of patients has also improved significantly.”

Wallace and colleagues reviewed information in the U.S. Renal Data System from 1995 to 2014 to analyze the temporal trends in mortality related to GPA caused by ESRD. After identifying a cohort with GPA caused by ESRD, the researchers divided patients into subgroups based on time of renal disease onset — 1995 to 1999, 2000 to 2004, 2005 to 2009 and 2010 to 2014. In all, 5,929 cases of GPA caused by ESRD were identified between 1995 and 2014.

Finally, the researchers determined trends in mortality rates and hazard ratios for overall death and cause-specific death.

According to the researchers, the mortality rate per 100 patient-years fell from 19 in 1995 to 1999 to 15.3 in 2010 to 2014 (HR = 0.77; 95% CI, 0.66-0.69). Further, mortality hazard ratios, after accounting for competing risk, were 0.61 (95% CI, 0.47-0.8) for cardiovascular disease and 0.42 (95% CI, 0.28-0.63) for infection (P < .001 for each).

“In part, [the improvement in mortality] is due to reductions in death due to cardiovascular disease and infection,” Wallace said. “However, these remain common causes of death and deserve further attention in future studies. We can continue to improve survival and other long-term outcomes for these patients through strategies that reduce the risks of infections and cardiovascular disease.” – by Jason Laday

Disclosure: The researchers report funding from the NIH.

Zachary S. Wallace

Researchers reported significant declines in the mortality rates of patients diagnosed with end-stage renal disease caused by granulomatosis with polyangiitis during the past 2 decades, which is likely due to improved management of such patients.

“While long-term survival has improved over the last two decades among patients with [granulomatosis with polyangiitis (GPA)], we did not know temporal trends in survival among patients with [end-stage renal disease (ESRD)] due to GPA,” Zachary S. Wallace, MD, of Massachusetts General Hospital, in Boston, told Healio Rheumatology. “In this study, we found that survival for this subgroup of patients has also improved significantly.”

Wallace and colleagues reviewed information in the U.S. Renal Data System from 1995 to 2014 to analyze the temporal trends in mortality related to GPA caused by ESRD. After identifying a cohort with GPA caused by ESRD, the researchers divided patients into subgroups based on time of renal disease onset — 1995 to 1999, 2000 to 2004, 2005 to 2009 and 2010 to 2014. In all, 5,929 cases of GPA caused by ESRD were identified between 1995 and 2014.

Finally, the researchers determined trends in mortality rates and hazard ratios for overall death and cause-specific death.

According to the researchers, the mortality rate per 100 patient-years fell from 19 in 1995 to 1999 to 15.3 in 2010 to 2014 (HR = 0.77; 95% CI, 0.66-0.69). Further, mortality hazard ratios, after accounting for competing risk, were 0.61 (95% CI, 0.47-0.8) for cardiovascular disease and 0.42 (95% CI, 0.28-0.63) for infection (P < .001 for each).

“In part, [the improvement in mortality] is due to reductions in death due to cardiovascular disease and infection,” Wallace said. “However, these remain common causes of death and deserve further attention in future studies. We can continue to improve survival and other long-term outcomes for these patients through strategies that reduce the risks of infections and cardiovascular disease.” – by Jason Laday

Disclosure: The researchers report funding from the NIH.