Factores asociados con el desarrollo de falla renal crónica terminal durante la hospitalización en los pacientes con poliangitis microscópica y granulomatosis con poliangitis en una población del noroccidente colombiano

Abstract

Introduction

ANCA vasculitis has been associated with increased morbidity and mortality, high disease burden, and organ damage, especially renal.

Objectives

To determine factors associated with end-stage kidney disease at hospital discharge in microscopic polyangiitis and granulomatosis with polyangiitis patients, to characterize our population, hospitalization causes, treatment received, and complications during stay.

Materials and methods

Adults with previous or new diagnosis of microscopic polyangiitis and granulomatosis with polyangiitis who required hospitalization between January 01, 2013, and April 30, 2021, were included. Association with end-stage kidney disease development was evaluated by Pearson's Chi2 (χ²) or Fisher's test, and Student's t or Mann-Whitney U test according to the nature of the variables. Exploratory multivariate models were made including factors associated with end-stage kidney disease.

Results

Forty-three patients were included, microscopic polyangiitis 55.8, and granulomatosis with polyangiitis 44.25. Twelve patients (27.9%) developed early end-stage kidney disease. High blood pressure, high urea nitrogen levels on admission, as well as pulmonary oedema, and Five Factor Score > 1 entailed a higher risk. In contrast, normal kidney function on admission was a protective factor. Rapidly progressive glomerulonephritis and arterial hypertension on admission were associated with end-stage kidney disease. In adjusted exploratory models according to vasculitis type, Birmingham Vasculitis Activity Score, diffuse alveolar haemorrhage, and plasma exchange use were identified as factors to include in multivariate models in multicentre studies.

Conclusion

88% of patients had renal involvement and 27.9% developed end-stage kidney disease. Rapidly progressive glomerulonephritis and arterial hypertension on hospital admission were associated with early development of end-stage kidney disease while normal renal function on admission was a protective factor for this outcome.