{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:47:15Z","timestamp":1786373235078,"version":"build-2736575974"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Kidney impairment of ANCA-associated vasculitides can lead to kidney failure. Patients with kidney failure may suffer from vasculitis relapses but are also at high risk of infections and cardiovascular events, which questions the maintenance of immunosuppressive therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting, participants, &amp; measurements<\/jats:title>\n                    <jats:p>Patients with ANCA-associated vasculitides initiating long-term dialysis between 2008 and 2012 in France registered in the national Renal Epidemiology and Information Network registry and paired with the National Health System database were included. We analyzed the proportion of patients in remission off immunosuppression over time and overall and event-free survival on dialysis (considering transplantation as a competing risk). We compared the incidence of vasculitis relapses, serious infections, cardiovascular events, and cancers before and after dialysis initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total, 229 patients were included: 142 with granulomatous polyangiitis and 87 with microscopic polyangiitis. Mean follow-up after dialysis initiation was 4.6\u00b12.7 years; 82 patients received a kidney transplant. The proportion of patients in remission off immunosuppression increased from 23% at dialysis initiation to 62% after 5 years. Overall survival rates on dialysis were 86%, 69%, and 62% at 1, 3, and 5 years, respectively. Main causes of death were infections (35%) and cardiovascular events (26%) but not vasculitis flares (6%). The incidence of vasculitis relapses decreased from 57 to seven episodes per 100 person-years before and after dialysis initiation (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.05). Overall, during follow-up, 45% of patients experienced a serious infection and 45% had a cardiovascular event, whereas 13% experienced a vasculitis relapse.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The proportion of patients with ANCA-associated vasculitis in remission off immunosuppression increases with time spent on dialysis. In this cohort, patients were far less likely to relapse from their vasculitis than to display serious infectious or cardiovascular events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Podcast<\/jats:title>\n                    <jats:p>This article contains a podcast at https:\/\/www.asn-online.org\/media\/podcast\/CJASN\/2021_11_08_CJN03190321.mp3<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.03190321","type":"journal-article","created":{"date-parts":[[2021,11,8]],"date-time":"2021-11-08T16:00:21Z","timestamp":1636387221000},"page":"1665-1675","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":29,"title":["Disease Activity and Adverse Events in Patients with ANCA-Associated Vasculitides Undergoing Long-Term Dialysis"],"prefix":"10.2215","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct03323476","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03635385","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Ma\u00eblis","family":"Kauffmann","sequence":"first","affiliation":[{"name":"Assistance Publique-H\u00f4pitaux de Marseille, University hospital de la Conception, Department of Nephrology, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9451-0372","authenticated-orcid":false,"given":"Micka\u00ebl","family":"Bobot","sequence":"additional","affiliation":[{"name":"Assistance Publique-H\u00f4pitaux de Marseille, University hospital de la Conception, Department of Nephrology, Marseille, France"},{"name":"Aix-Marseille Univ, Center for Cardio-Vascular and Nutrition research, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7580-0913","authenticated-orcid":false,"given":"Thomas","family":"Robert","sequence":"additional","affiliation":[{"name":"Assistance Publique-H\u00f4pitaux de Marseille, University hospital de la Conception, Department of Nephrology, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phane","family":"Burtey","sequence":"additional","affiliation":[{"name":"Assistance Publique-H\u00f4pitaux de Marseille, University hospital de la Conception, Department of Nephrology, Marseille, France"},{"name":"Aix-Marseille Univ, Center for Cardio-Vascular and Nutrition research, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gr\u00e9goire","family":"Couvrat-Desvergnes","sequence":"additional","affiliation":[{"name":"Hospital La Roche sur Yon\u2013Vend\u00e9e, Department of Nephrology, La Roche sur Yon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fr\u00e9d\u00e9ric","family":"Lavainne","sequence":"additional","affiliation":[{"name":"University hospital de Nantes, Department of Nephrology and Clinical Immunology, Nantes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3573-9203","authenticated-orcid":false,"given":"Xavier","family":"Pu\u00e9chal","sequence":"additional","affiliation":[{"name":"Assistance Publique-H\u00f4pitaux de Paris, H\u00f4pital Cochin, Department of Internal Medicine, Centre de R\u00e9f\u00e9rence des Maladies Auto-immunes Syst\u00e9miques Rares d'Ile-de-France, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Terrier","sequence":"additional","affiliation":[{"name":"Assistance Publique-H\u00f4pitaux de Paris, H\u00f4pital Cochin, Department of Internal Medicine, Centre de R\u00e9f\u00e9rence des Maladies Auto-immunes Syst\u00e9miques Rares d'Ile-de-France, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Qu\u00e9m\u00e9neur","sequence":"additional","affiliation":[{"name":"Hospital de Valenciennes, Department of Internal Medicine, Valenciennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanislas","family":"Faguer","sequence":"additional","affiliation":[{"name":"University hospital de Toulouse, H\u00f4pital Rangueil, Department of Nephrology and Organ Transplantation, Centre de r\u00e9f\u00e9rence des maladies r\u00e9nales rares, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, Institut des Maladies M\u00e9taboliques et Cardiovasculaires, Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3075-7739","authenticated-orcid":false,"given":"Alexandre","family":"Karras","sequence":"additional","affiliation":[{"name":"Assistance Publique-H\u00f4pitaux de Paris, H\u00f4pital Europ\u00e9en Georges Pompidou, Department of Nephrology, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Brunet","sequence":"additional","affiliation":[{"name":"Assistance Publique-H\u00f4pitaux de Marseille, University hospital de la Conception, Department of Nephrology, Marseille, France"},{"name":"Aix-Marseille Univ, Center for Cardio-Vascular and Nutrition research, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9cile","family":"Couchoud","sequence":"additional","affiliation":[{"name":"Agence de la Biom\u00e9decine, Registre Renal Epidemiology and Information Network, Saint-Denis, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9315-1577","authenticated-orcid":false,"given":"No\u00e9mie","family":"Jourde-Chiche","sequence":"additional","affiliation":[{"name":"Assistance Publique-H\u00f4pitaux de Marseille, University hospital de la Conception, Department of Nephrology, Marseille, France"},{"name":"Aix-Marseille Univ, Center for Cardio-Vascular and Nutrition research, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,11]]},"reference":[{"key":"B1-20241015","doi-asserted-by":"crossref","first-page":"102495","DOI":"10.1016\/j.autrev.2020.102495","article-title":"Clinical associations of renal involvement in ANCA-associated vasculitis","volume":"19","author":"Kronbichler","year":"2020","journal-title":"Autoimmun Rev"},{"key":"B2-20241015","doi-asserted-by":"crossref","first-page":"102467","DOI":"10.1016\/j.jaut.2020.102467","article-title":"Microscopic polyangiitis: Clinical characteristics and long-term outcomes of 378 patients from the French Vasculitis Study Group Registry","volume":"112","author":"Nguyen","year":"2020","journal-title":"J Autoimmun"},{"key":"B3-20241015","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/j.semarthrit.2015.07.009","article-title":"Improved survival in granulomatosis with polyangiitis: A general population-based study","volume":"45","author":"Wallace","year":"2016","journal-title":"Semin Arthritis Rheum"},{"key":"B4-20241015","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1016\/j.kint.2018.07.020","article-title":"Development and validation of a renal risk score in ANCA-associated glomerulonephritis","volume":"94","author":"Brix","year":"2018","journal-title":"Kidney Int"},{"key":"B5-20241015","doi-asserted-by":"crossref","first-page":"1709","DOI":"10.2215\/CJN.01020113","article-title":"Renal survival in proteinase 3 and myeloperoxidase ANCA-associated systemic vasculitis","volume":"8","author":"de Joode","year":"2013","journal-title":"Clin J Am Soc Nephrol"},{"key":"B6-20241015","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1093\/qjmed\/hcu043","article-title":"Survival of patients with ANCA-associated vasculitis on chronic dialysis: Data from the French REIN registry from 2002 to 2011","volume":"107","author":"Romeu","year":"2014","journal-title":"QJM"},{"key":"B7-20241015","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1159\/000072990","article-title":"Current attitudes to the therapy of vasculitis","volume":"26","author":"Jayne","year":"2003","journal-title":"Kidney Blood Press Res"},{"key":"B8-20241015","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.1056\/NEJMoa1404231","article-title":"Rituximab versus azathioprine for maintenance in ANCA-associated vasculitis","volume":"371","author":"Guillevin","year":"2014","journal-title":"N Engl J Med"},{"key":"B9-20241015","doi-asserted-by":"crossref","first-page":"179","DOI":"10.7326\/M19-3827","article-title":"Long-term rituximab use to maintain remission of antineutrophil cytoplasmic antibody-associated vasculitis: A randomized trial","volume":"173","author":"Charles","year":"2020","journal-title":"Ann Intern Med"},{"key":"B10-20241015","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1002\/art.33361","article-title":"Risk factors for relapse of antineutrophil cytoplasmic antibody-associated vasculitis","volume":"64","author":"Walsh","year":"2012","journal-title":"Arthritis Rheum"},{"key":"B11-20241015","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1038\/ki.2009.218","article-title":"The clinical course of ANCA small-vessel vasculitis on chronic dialysis","volume":"76","author":"Lionaki","year":"2009","journal-title":"Kidney Int"},{"key":"B12-20241015","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1053\/j.ajkd.2007.04.018","article-title":"Recurrences and infections during continuous immunosuppressive therapy after beginning dialysis in ANCA-associated vasculitis","volume":"50","author":"Weidanz","year":"2007","journal-title":"Am J Kidney Dis"},{"key":"B13-20241015","doi-asserted-by":"crossref","first-page":"416","DOI":"10.2215\/CJN.07300712","article-title":"Lymphopenia and treatment-related infectious complications in ANCA-associated vasculitis","volume":"8","author":"Goupil","year":"2013","journal-title":"Clin J Am Soc Nephrol"},{"key":"B14-20241015","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1007\/s00393-011-0756-z","article-title":"[Development of morbidity and mortality in ANCA-associated vasculitis]","volume":"70","author":"Reinhold-Keller","year":"2011","journal-title":"Z Rheumatol"},{"key":"B15-20241015","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1159\/000063556","article-title":"Incidence of infectious morbidity and mortality in dialysis patients","volume":"20","author":"Vanholder","year":"2002","journal-title":"Blood Purif"},{"key":"B16-20241015","doi-asserted-by":"crossref","first-page":"1758","DOI":"10.1111\/j.1523-1755.2000.00337.x","article-title":"Mortality caused by sepsis in patients with end-stage renal disease compared with the general population","volume":"58","author":"Sarnak","year":"2000","journal-title":"Kidney Int"},{"key":"B17-20241015","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1111\/j.1525-139X.2006.00175.x","article-title":"Neutrophil dysfunction and infection risk in end-stage renal disease","volume":"19","author":"Chonchol","year":"2006","journal-title":"Semin Dial"},{"issue":"Suppl 2","key":"B18-20241015","first-page":"S145","article-title":"[REIN\u2019s objectives and organization]","volume":"5","year":"2009","journal-title":"Nephrol Ther"},{"key":"B19-20241015","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s12882-020-1692-4","article-title":"Linking disease registries and nationwide healthcare administrative databases: The French Renal Epidemiology and Information Network (REIN) insight","volume":"21","author":"Raffray","year":"2020","journal-title":"BMC Nephrol"},{"key":"B20-20241015","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/S0169-2607(03)00069-5","article-title":"SAS macros for estimation of the cumulative incidence functions based on a Cox regression model for competing risks survival data","volume":"74","author":"Rosth\u00f8j","year":"2004","journal-title":"Comput Methods Programs Biomed"},{"key":"B21-20241015","doi-asserted-by":"crossref","first-page":"1606","DOI":"10.2215\/CJN.03460412","article-title":"Vascular disease, ESRD, and death: Interpreting competing risk analyses","volume":"7","author":"Grams","year":"2012","journal-title":"Clin J Am Soc Nephrol"},{"key":"B22-20241015","doi-asserted-by":"crossref","first-page":"240","DOI":"10.2215\/CJN.05610611","article-title":"Glucocorticoids and relapse and infection rates in anti-neutrophil cytoplasmic antibody disease","volume":"7","author":"McGregor","year":"2012","journal-title":"Clin J Am Soc Nephrol"},{"key":"B23-20241015","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1016\/S0272-6386(03)00025-8","article-title":"Outcome of ANCA-associated renal vasculitis: A 5-year retrospective study","volume":"41","author":"Booth","year":"2003","journal-title":"Am J Kidney Dis"},{"key":"B24-20241015","doi-asserted-by":"crossref","first-page":"905","DOI":"10.2215\/CJN.08290813","article-title":"Predictors of treatment outcomes in ANCA-associated vasculitis with severe kidney failure","volume":"9","author":"Lee","year":"2014","journal-title":"Clin J Am Soc Nephrol"},{"issue":"Suppl 70","key":"B25-20241015","first-page":"S104","article-title":"Should immunosuppressives be stopped in granulomatosis with polyangiitis (Wegener\u2019s granulomatosis) patients undergoing dialysis?","volume":"30","author":"B\u00fcy\u00fcktas","year":"2012","journal-title":"Clin Exp Rheumatol"},{"key":"B26-20241015","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1681\/ASN.V971258","article-title":"Outcome of renal replacement therapy in antineutrophil cytoplasmic antibody-associated systemic vasculitis","volume":"9","author":"Allen","year":"1998","journal-title":"J Am Soc Nephrol"},{"key":"B27-20241015","doi-asserted-by":"crossref","first-page":"110","DOI":"10.3109\/14397595.2015.1045255","article-title":"A retrospective study on the outcomes of MPO-ANCA-associated vasculitis in dialysis-dependent patients","volume":"26","author":"Hasegawa","year":"2016","journal-title":"Mod Rheumatol"},{"key":"B28-20241015","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1159\/000063558","article-title":"Immune system dysregulation in uremia: Role of oxidative stress","volume":"20","author":"Descamps-Latscha","year":"2002","journal-title":"Blood Purif"},{"key":"B29-20241015","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1038\/s41581-018-0098-z","article-title":"Endothelium structure and function in kidney health and disease","volume":"15","author":"Jourde-Chiche","year":"2019","journal-title":"Nat Rev Nephrol"},{"key":"B30-20241015","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1111\/j.1525-139X.2011.00925.x","article-title":"Vascular incompetence in dialysis patients--protein-bound uremic toxins and endothelial dysfunction","volume":"24","author":"Jourde-Chiche","year":"2011","journal-title":"Semin Dial"},{"key":"B31-20241015","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1007\/s10067-012-1957-9","article-title":"Disease activity in systemic lupus erythematosus patients with end-stage renal disease: Systematic review of the literature","volume":"31","author":"Mattos","year":"2012","journal-title":"Clin Rheumatol"},{"key":"B32-20241015","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/0002-9343(90)90295-O","article-title":"Systemic lupus erythematosus: Analysis of disease activity in 55 patients with end-stage renal failure treated with hemodialysis or continuous ambulatory peritoneal dialysis","volume":"89","author":"Nossent","year":"1990","journal-title":"Am J Med"},{"issue":"Suppl 1","key":"B33-20241015","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1016\/S1769-7255(13)70036-1","article-title":"[REIN Report 2011--summary]","volume":"9","author":"Couchoud","year":"2013","journal-title":"Nephrol Ther"},{"key":"B34-20241015","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1093\/ndt\/13.7.1713","article-title":"Survival and vasculitis activity in patients with end-stage renal disease due to Wegener\u2019s granulomatosis","volume":"13","author":"Haubitz","year":"1998","journal-title":"Nephrol Dial Transplant"},{"key":"B35-20241015","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1002\/art.24386","article-title":"Increased morbidity from ischemic heart disease in patients with Wegener\u2019s granulomatosis","volume":"60","author":"Faurschou","year":"2009","journal-title":"Arthritis Rheum"},{"key":"B36-20241015","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.berh.2012.12.004","article-title":"Cardiovascular disease due to accelerated atherosclerosis in systemic vasculitides","volume":"27","author":"Cohen Tervaert","year":"2013","journal-title":"Best Pract Res Clin Rheumatol"},{"issue":"Suppl","key":"B37-20241015","first-page":"S16","article-title":"Epidemiology of cardiovascular disease in chronic renal disease","volume":"9","author":"Foley","year":"1998","journal-title":"J Am Soc Nephrol"},{"issue":"Suppl 1","key":"B38-20241015","first-page":"S13","article-title":"Special characteristics of atherosclerosis in chronic renal failure","volume":"60","author":"Amann","year":"2003","journal-title":"Clin Nephrol"},{"key":"B39-20241015","doi-asserted-by":"crossref","first-page":"773","DOI":"10.2215\/CJN.08770812","article-title":"The outcomes of patients with ESRD and ANCA-associated vasculitis in Australia and New Zealand","volume":"8","author":"Tang","year":"2013","journal-title":"Clin J Am Soc Nephrol"}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.03190321","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:43:51Z","timestamp":1786369431000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.03190321"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11]]},"references-count":39,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.03190321","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11]]},"assertion":[{"value":"2021-03-02","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-09-08","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}