TY - JOUR
T1 - Outcomes in ANCA-associated vasculitis in Scotland
T2 - validation of the renal risk score in a complete national cohort
AU - McGovern, Dominic P.
AU - Lees, Jennifer S.
AU - Traynor, Jamie P.
AU - Mackinnon, Bruce
AU - Bell, Samira
AU - Hunter, Robert W.
AU - Dhaun, Neeraj
AU - Metcalfe, Wendy
AU - Kidder, Dana
AU - Lim, Michelle
AU - Joss, Nicola
AU - Kelly, Michael
AU - Taylor, Alison
AU - Causland, Zoe
AU - Dey, Vishal
AU - Buck, Kate
AU - Brix, Silke
AU - Geddes, Colin C.
AU - McQuarrie, Emily P.
AU - Stevens, Kathryn I.
N1 - Funding Information:
JSL has received personal honoraria from AstraZeneca, Bristol Myers Squibb, and Pfizer. MK has received personal honoraria from AstraZeneca and has received support from Napp Pharmaceuticals for attending a meeting. SB is the recipient of grants from Wellcome Accelerator and Kidney for Life and has received consulting fees/personal honoraria/support for attending meetings from Vifor. EM has received personal honoraria from AstraZeneca and Pharmacosmos. KIS has consulted for Bayer AG and Boehringer Ingelheim. All the other authors have declared no competing interests.
Copyright:
© 2023 International Society of Nephrology. Published by Elsevier Inc.
PY - 2023/8
Y1 - 2023/8
N2 - Introduction: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) causes autoimmune-mediated inflammation of small blood vessels in multiple organs, including the kidneys. The ability to accurately predict kidney outcomes would enable a more personalized therapeutic approach.Methods: We used our national renal biopsy registry to validate the ability of ANCA Renal Risk Score (ARRS) to predict end-stage kidney disease (ESKD) for individual patients. This score uses histopathological and biochemical data to stratify patients as high, medium, or low risk for developing ESKD.Results: A total of 288 patients were eligible for inclusion in the study (low risk n = 144, medium risk n = 122, high risk n = 12). Using adjusted Cox proportional hazard models with the low-risk group as reference, we show that outcome differs between the categories: high-risk hazard ratio (HR) 16.69 (2.91–95.81, P = 0.002); medium risk HR 4.14 (1.07–16.01, P = 0.039). Incremental multivariable-adjusted Cox proportional hazards models demonstrated that adding ARRS to a model adjusted for multiple clinical parameters enhanced predictive discrimination (basic model C-statistic 0.864 [95% CI 0.813–0.914], basic model plus ARRS C-statistic 0.877 [95% CI 0.823–0.931]; P <0.01).Conclusion: The ARRS better discriminates risk of ESKD in AAV and offers clinicians more prognostic information than the use of standard biochemical and clinical measures alone. This is the first time the ARRS has been validated in a national cohort. The proportion of patients with high-risk scores is lower in our cohort compared to others and should be noted as a limitation of this study.
AB - Introduction: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) causes autoimmune-mediated inflammation of small blood vessels in multiple organs, including the kidneys. The ability to accurately predict kidney outcomes would enable a more personalized therapeutic approach.Methods: We used our national renal biopsy registry to validate the ability of ANCA Renal Risk Score (ARRS) to predict end-stage kidney disease (ESKD) for individual patients. This score uses histopathological and biochemical data to stratify patients as high, medium, or low risk for developing ESKD.Results: A total of 288 patients were eligible for inclusion in the study (low risk n = 144, medium risk n = 122, high risk n = 12). Using adjusted Cox proportional hazard models with the low-risk group as reference, we show that outcome differs between the categories: high-risk hazard ratio (HR) 16.69 (2.91–95.81, P = 0.002); medium risk HR 4.14 (1.07–16.01, P = 0.039). Incremental multivariable-adjusted Cox proportional hazards models demonstrated that adding ARRS to a model adjusted for multiple clinical parameters enhanced predictive discrimination (basic model C-statistic 0.864 [95% CI 0.813–0.914], basic model plus ARRS C-statistic 0.877 [95% CI 0.823–0.931]; P <0.01).Conclusion: The ARRS better discriminates risk of ESKD in AAV and offers clinicians more prognostic information than the use of standard biochemical and clinical measures alone. This is the first time the ARRS has been validated in a national cohort. The proportion of patients with high-risk scores is lower in our cohort compared to others and should be noted as a limitation of this study.
KW - ANCA Renal Risk Score (ARRS)
KW - ANCA-associated vasculitis (AAV)
KW - biopsy registry
KW - end-stage kidney disease (ESKD)
UR - http://www.scopus.com/inward/record.url?scp=85164360350&partnerID=8YFLogxK
U2 - 10.1016/j.ekir.2023.05.029
DO - 10.1016/j.ekir.2023.05.029
M3 - Article
C2 - 37547534
SN - 2468-0249
VL - 8
SP - 1648
EP - 1656
JO - Kidney International Reports
JF - Kidney International Reports
IS - 8
ER -