In the Journals

IgA vasculitis linked to higher risk for hypertension, chronic kidney disease

Patients with IgA vasculitis, also known as Henoch-Schönlein purpura, are at an increased risk for hypertension and chronic kidney disease compared to those without the condition, according to recent findings in the Annals of the Rheumatic Diseases.

“IgA [vasculitis] may be complicated by glomerulonephritis and it is thought that adult-onset IgA [vasculitis] is associated with increased risk and severity of renal involvement compared with childhood disease,” Lorraine Harper, PhD, MRCP, of the University of Birmingham, in the United Kingdom, and colleagues wrote. “However, long-term health outcomes of adult-onset IgA [vasculitis] are not well characterized.”

To determine the incidence of IgA vasculitis in adults and children, and evaluate the risk for complications in the disease, Harper and colleagues drew data from The Health Improvement Network (THIN), which includes medical records for 3.6 million active patients from more than 675 general practices in the United Kingdom. Using this database, researchers conducted an open, retrospective matched cohort study of cardiovascular, venous thrombotic and renal outcomes among patients with adult-onset and childhood-onset IgA vasculitis.

 
Patients with IgA vasculitis are at an increased risk for hypertension and chronic kidney disease, according to data.
Source: Shutterstock

Harper and colleagues included 2,828 patients with adult-onset IgA vasculitis in their study, and matched them based on age and sex with 5,655 control participants. A total of 10,405 patients with childhood-onset IgA vasculitis were also included, and matched to 20,810 control participants. The researchers calculated adjusted HRs using Cox proportional hazards models.

According to the researchers, the incidence of childhood-onset IgA vasculitis between 2005 and 2016 was 27.22 per 100,000 person-years, while the incident rate for the adult-onset form of the disease was 2.2 per 100,000 person-years.

The risk for hypertension was significantly increased among patients with adult-onset (adjusted HR = 1.42; 95%, CI 1.19-1.7) and childhood-onset (aHR = 1.52; 95% CI, 1.22-1.89) IgA vasculitis. The risk for stage G3 to stage G5 chronic kidney disease was also significantly increased among patients with adult-onset (aHR = 1.54; 95% CI, 1.23-1.93) and childhood-onset (aHR = 1.89; 95% CI, 1.16-3.07) IgA vasculitis. In addition, all-cause mortality was increased among those with the adult-onset form of the disease, compared with the control group (aHR = 1.27; 95% CI, 1.07-1.5).

There was no evidence of any association between IgA vasculitis and ischemic heart disease, cerebrovascular disease or venous thromboembolism.

“These findings emphasize the importance of blood pressure and renal function monitoring in patients with IgA [vasculitis],” Harper and colleagues wrote. “Our data also suggest that IgA [vasculitis] should not be considered a ‘single hit’ disease, but that clinicians should monitor for long-term sequelae. Further research is required to clarify the cause of hypertension in patients with IgA [vasculitis], and to investigate whether such patients suffer from additional long-term sequelae than that are currently unrecognized.” – by Jason Laday

Disclosure: Harper reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Patients with IgA vasculitis, also known as Henoch-Schönlein purpura, are at an increased risk for hypertension and chronic kidney disease compared to those without the condition, according to recent findings in the Annals of the Rheumatic Diseases.

“IgA [vasculitis] may be complicated by glomerulonephritis and it is thought that adult-onset IgA [vasculitis] is associated with increased risk and severity of renal involvement compared with childhood disease,” Lorraine Harper, PhD, MRCP, of the University of Birmingham, in the United Kingdom, and colleagues wrote. “However, long-term health outcomes of adult-onset IgA [vasculitis] are not well characterized.”

To determine the incidence of IgA vasculitis in adults and children, and evaluate the risk for complications in the disease, Harper and colleagues drew data from The Health Improvement Network (THIN), which includes medical records for 3.6 million active patients from more than 675 general practices in the United Kingdom. Using this database, researchers conducted an open, retrospective matched cohort study of cardiovascular, venous thrombotic and renal outcomes among patients with adult-onset and childhood-onset IgA vasculitis.

 
Patients with IgA vasculitis are at an increased risk for hypertension and chronic kidney disease, according to data.
Source: Shutterstock

Harper and colleagues included 2,828 patients with adult-onset IgA vasculitis in their study, and matched them based on age and sex with 5,655 control participants. A total of 10,405 patients with childhood-onset IgA vasculitis were also included, and matched to 20,810 control participants. The researchers calculated adjusted HRs using Cox proportional hazards models.

According to the researchers, the incidence of childhood-onset IgA vasculitis between 2005 and 2016 was 27.22 per 100,000 person-years, while the incident rate for the adult-onset form of the disease was 2.2 per 100,000 person-years.

The risk for hypertension was significantly increased among patients with adult-onset (adjusted HR = 1.42; 95%, CI 1.19-1.7) and childhood-onset (aHR = 1.52; 95% CI, 1.22-1.89) IgA vasculitis. The risk for stage G3 to stage G5 chronic kidney disease was also significantly increased among patients with adult-onset (aHR = 1.54; 95% CI, 1.23-1.93) and childhood-onset (aHR = 1.89; 95% CI, 1.16-3.07) IgA vasculitis. In addition, all-cause mortality was increased among those with the adult-onset form of the disease, compared with the control group (aHR = 1.27; 95% CI, 1.07-1.5).

There was no evidence of any association between IgA vasculitis and ischemic heart disease, cerebrovascular disease or venous thromboembolism.

“These findings emphasize the importance of blood pressure and renal function monitoring in patients with IgA [vasculitis],” Harper and colleagues wrote. “Our data also suggest that IgA [vasculitis] should not be considered a ‘single hit’ disease, but that clinicians should monitor for long-term sequelae. Further research is required to clarify the cause of hypertension in patients with IgA [vasculitis], and to investigate whether such patients suffer from additional long-term sequelae than that are currently unrecognized.” – by Jason Laday

Disclosure: Harper reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.