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See Latest ArticlesThe clinical course of ANCA small-vessel vasculitis on chronic dialysis
Kidney International, 06/22/09
Lionaki S et al. - Infections were almost twice as frequent among patients with ESRD on maintenance immunosuppressants and were an important cause of death. Given the lower risk of relapse and higher risk of infection and death, it is suggested that immunosuppression be geared to patients with ESRD who present with active vasculitis.
Sofia Lionaki, 07/01/09
| Commentary Fear of disease relapse has lead physicians to continue maintenance immunosuppressive therapy in patients with ANCA vasculitis, including after end stage kidney disease (ESKD). In the absence of direct evidence that relapses are effectively prevented by continued immunosuppression, the possible benefit of such therapy must be weighed against the potential risks. Among patients with ESKD, our data reveal that the rate of disease relapse is significantly lower when compared to the same patients before ESKD and to patients with preserved renal function, while the risk of serious infections is elevated, especially among those on immunosuppressants. These findings suggest that the risks of maintenance immunosuppression may outweigh the potential benefit in this patient population, and its use should be reserved to patients with active vasculitis. |
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