Outcomes of Elderly Patients with Anti-Neutrophil Cytoplasmic Autoantibody-Associated Vasculitis Treated with Immunosuppressive Therapy

摘要

Background/Aims: Anti-neutrophil cytoplasmic autoanti-body-associated vasculitis (AAV) is a cause of biopsy-proven acute kidney injury, more common in the elderly. Treatment requires immunosuppression, which can have significant toxic effects. The aim of this study was to assess whether morbidity and mortality that are associated with immunosuppression for AAV varied with age. Methods: A retrospective review of 232 patients given induction therapy with prednisolone and cyclophosphamide was conducted. Information was collected on baseline characteristics (including requirement for dialysis at presentation) and the occurrence of leukopenia, infection, end-stage renal disease and death during follow-up. Results: Median follow-up was 51 months. Older patients (aged >70 years) were treated with lower total cyclophosphamide doses than those aged <70 years (mean 7.3 g (SD4.4) vs. 10.7 g (SD 7.4), respectively). Increasing age was associated with an increased risk of leukopenia (odds ratio (OR) 1.50; 95% confidence interval (Cl) 1.20-1.86; p < 0.001), and older patients were more likely to develop infections in the first year (OR 1.87; 95% Cl 1.1 -3.2). Older patients were also significantly more likely to require dialysis at presentation (OR 1.66; 95% Cl 1.13-2.5) and longer term.