A cohort study to investigate sex-specific differences in ANCA-associated glomerulonephritis outcomes

Data surrounding sex-specific differences in ANCA-associated vasculitis glomerulonephritis (ANCA-GN) outcomes is sparse. We hypothesised that the previously observed increased risk of end-stage kidney disease (ESKD) in males is driven by sex-specific variation in immunosuppression dosing. Patients w...

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Bibliographic Details
Published in:Scientific reports 2021-06, Vol.11 (1), p.13080-13080, Article 13080
Main Authors: Scott, Jennifer, Canepa, Carolina, Buettner, Antonia, Ryan, Louise, Moloney, Bróna, Cormican, Sarah, Walsh, Cathal, White, Arthur, Salama, Alan D., Little, Mark A.
Format: Article
Language:English
Subjects:
692/4022/1585/104
692/4022/1585/2759
Antineutrophil cytoplasmic antibodies
Biopsy
Cohort analysis
Creatinine
Dosage
Drug dosages
End-stage renal disease
Glomerulonephritis
Humanities and Social Sciences
Immunosuppression
Kidney diseases
Kidneys
Males
multidisciplinary
Patients
Prednisolone
Science
Science (multidisciplinary)
Serology
Sex
Sexes
Survival
Vasculitis
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Summary:Data surrounding sex-specific differences in ANCA-associated vasculitis glomerulonephritis (ANCA-GN) outcomes is sparse. We hypothesised that the previously observed increased risk of end-stage kidney disease (ESKD) in males is driven by sex-specific variation in immunosuppression dosing. Patients were recruited to the Irish Rare Kidney Disease Registry or followed by the Royal Free Hospital vasculitis team (2012–2020). Inclusion criteria: prior diagnosis of ANCA-GN (biopsy proven pauci-immune glomerulonephritis) and positive serology for anti-MPO or -PR3 antibodies. Renal and patient survival, stratified by sex and Berden histological class, was analysed. The cumulative- and starting dose/kilogram of induction agents and prednisolone, respectively, was compared between sexes. 332 patients were included. Median follow-up was time 40.2 months (IQR 17.3–69.2). 73 (22%) reached ESKD and 47 (14.2%) died. Overall 1- and 5-year renal survival was 82.2% and 76.7% in males and 87.1% and 82.0% in females, respectively ( p 0.13). The hazard ratio for ESKD in males versus females, after adjustment for age, ANCA serology, baseline creatinine and histological class was 1.07 (95% CI 0.59–1.93). There was no difference between sexes in the dose/kilogram of any induction agent. We did not observe a strong impact of sex on renal outcome in ANCA-GN. Treatment intensity does not vary by sex.
ISSN:2045-2322
2045-2322
DOI:10.1038/s41598-021-92629-7