Since the 1990s, the risk of death has decreased for patients with end stage renal disease due to granulomatosis with polyangiitis (GPA-ESRD), reports a study in Arthritis Care & Research.
From the US Renal Data System, the researchers identified 5929 patients diagnosed with GPA-ESRD between 1995 and 2014, representing nearly all incident cases during that time. Trends in overall and cause-specific mortality were analyzed in subgroups of patients defined by year of ESRD onset: 1995–99, 2000–04, 2005–09, and 2010–14. The overall incidence of GPA-ESRD per million population increased from 0.81 in 1995–99 to 1.15 in 2005–09, stabilizing at 1.12 in 2010–14.
Mortality per 100 patient-years decreased throughout the period studied: from 19.0 in 1995–99, to 16.9 in 2000–04, to 16.2 in 2005–09, to 15.3 in 2010–14. The adjusted hazard ratio for death in the 2010–14 cohort was 0.77, compared to the 1995–99 cohort. The improvement in overall mortality was unaffected by further adjustment for body mass index, smoking, comorbid conditions, region, and initial ESRD therapy modality. On analysis accounting for competing risks, HRs were 0.61 for death from cardiovascular disease and 0.42 for death from infection.
Patients with GPA are at risk of kidney involvement leading to ESRD. The new study is the first to analyze US national trends in the incidence and mortality of GPA-ESRD.
The results show significant improvements in overall and cause-specific mortality from GPA-ESRD over the past two decades. While the specific factors responsible for gains cannot be identified, the findings “likely reflect improved management of both GPA and ESRD,” the researchers write [Wallace ZS, et al. Improving mortality in end-stage renal disease due to granulomatosis with polyangiitis from 1995 to 2014. Arthritis Care Res (Hoboken) 2018; DOI: 10.1002/acr.23521].