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Abstract
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.
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1 Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Dublin, Ireland (GRID:grid.8217.c) (ISNI:0000 0004 1936 9705)
2 UCL Department of Renal Medicine, Royal Free Hospital, London, UK (GRID:grid.426108.9) (ISNI:0000 0004 0417 012X)
3 Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Dublin, Ireland (GRID:grid.8217.c) (ISNI:0000 0004 1936 9705); National University of Ireland, Regenerative Medical Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, School, College of Medicine, Nursing and Health Sciences, Galway, Ireland (GRID:grid.6142.1) (ISNI:0000 0004 0488 0789)
4 University of Limerick, Department of Mathematics and Statistics, Limerick, Ireland (GRID:grid.10049.3c) (ISNI:0000 0004 1936 9692)
5 Trinity College Dublin, The University of Dublin, Department of Statistics, Dublin, Ireland (GRID:grid.8217.c) (ISNI:0000 0004 1936 9705)
6 Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Dublin, Ireland (GRID:grid.8217.c) (ISNI:0000 0004 1936 9705); Tallaght University Hospital, Irish Centre for Vascular Biology, Dublin, Ireland (GRID:grid.413305.0) (ISNI:0000 0004 0617 5936)