Acute kidney injury (AKI) develops in the vast majority of patients hospitalized with newly diagnosed ANCA-associated vasculitis (AAV), and many patients require inpatient dialysis, according to a recent report.
“AAV with acute kidney involvement remains a challenging, high-risk condition,” Jianling Tao, MD, of Stanford University School of Medicine in Palo Alto, California, and colleagues concluded in a paper published in Glomerular Diseases. “Maintaining a high index of suspicion and a low threshold for kidney biopsy should help ameliorate short- and long-term complications.”
The latest findings are from an analysis of 2016-2020 data from the National Inpatient Sample, which contains discharge-level data from approximately 20% of all US hospital admissions. Investigators identified 1329 patients with AAV and concurrent inpatient native kidney biopsies and no kidney failure prior to admission. They examined hospital complications according to AAV subtype: granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic GPA (EGPA). Subtype was not designated is more than 50% of cases. The authors categorized these cases as unspecified vasculitis.
Depending on AAV subtype, the prevalence of AKI among patients with EGPA, unspecified vasculitis, GPA, and MPA was 85.7%, 90.0%, 91.5%, and 94.9%, respectively, the investigators reported. The proportion of patients requiring inpatient dialysis was approximately 24% overall and 4.8%, 19.6%, 24.1%, and 24.6% of patients with EGPA, unspecified vasculitis, GPA, and MPA, respectively. Hypoxia developed in 4.8%, 17.4%, 23.2%, and 23.2% of patients, respectively. In addition, 10.2%, 20.4%, and 20.6% of patients with unspecified vasculitis, GPA, and MPA received inpatient plasmapheresis, respectively.
The investigators observed no significant differences in adjusted hospital length of stay or inpatient costs among AAV subtypes. Patients hospitalized in the Midwest had shorter hospital stays and lower costs compared with the Northeast, South, or West, according to the authors.
References:
Tao J, Montez-Rath M, Charu V, Chertow GM. Antineutrophil cytoplasmic antibody-associated vasculitis with active kidney involvement in the United States: 2016-2020. Glomerular Dis. 2024;4-33-42. doi:10.1159/000536168