PMID- 24756532
OWN - NLM
STAT- MEDLINE
DCOM- 20150511
LR  - 20211021
IS  - 1573-2584 (Electronic)
IS  - 0301-1623 (Linking)
VI  - 46
IP  - 8
DP  - 2014 Aug
TI  - Clinical outcomes of ANCA-associated vasculitis in elderly patients.
PG  - 1595-600
LID - 10.1007/s11255-014-0717-y [doi]
AB  - BACKGROUND: Older age is independently associated with mortality in patients with 
      anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). We hypothesized 
      that a reduced-dose immunosuppressive treatment would result in similar 
      effectiveness and comparable treatment-related morbidity in elderly patients as 
      the regular dose in younger patients. We also postulated that the higher baseline 
      comorbidities may contribute to the higher mortality of the elderly subjects. 
      METHODS: Ninety-three consecutive patients with AAV between 1998 and 2012 were 
      retrospectively analyzed. Forty-one individuals were defined as "elderly" (age 
      >65 years) and 52 as "younger" (age <65 years). All cause and cardiovascular 
      mortality, death due to vasculitis and infections, and effectiveness of 
      "reduced-dose" immunosuppressive treatment in the elderly group were compared to 
      the effects of "full-dose" treatment in younger individuals. RESULTS: Mortality 
      in the elderly group was higher (p = 0.007). Cardiovascular death was 
      significantly increased (p = 0.002) in the elderly, but mortality due to 
      vasculitis or infections was comparable. Treatment effectiveness was also similar 
      in elderly and younger patients. At the end of the first follow-up year, 37 % of 
      the elderly and 27 % of the younger patients died (p = 0.22). In univariate Cox 
      regression analyses, being older than 65 year, having cardiovascular disease at 
      baseline, need for dialysis at diagnosis, and lower serum albumin were associated 
      with an increased hazard of mortality. CONCLUSIONS: Delivering reduced dose of 
      immunosuppression for elderly patients was associated with satisfactory outcome 
      and favorable treatment-related complication profile. The higher mortality in the 
      elderly could be attributed mainly to baseline cardiovascular morbidity.
FAU - Haris, Agnes
AU  - Haris A
AD  - Nephrology Department, Szent Margit Hospital, 132 Becsi Street, Budapest, 1032, 
      Hungary, agnesharis@hotmail.com.
FAU - Polner, Kalman
AU  - Polner K
FAU - Aranyi, Jozsef
AU  - Aranyi J
FAU - Braunitzer, Henrik
AU  - Braunitzer H
FAU - Kaszas, Ilona
AU  - Kaszas I
FAU - Mucsi, Istvan
AU  - Mucsi I
LA  - eng
PT  - Journal Article
DEP - 20140423
PL  - Netherlands
TA  - Int Urol Nephrol
JT  - International urology and nephrology
JID - 0262521
RN  - 0 (Anti-Inflammatory Agents)
RN  - 0 (Immunosuppressive Agents)
RN  - 0 (Serum Albumin)
RN  - 8N3DW7272P (Cyclophosphamide)
RN  - MRK240IY2L (Azathioprine)
RN  - X4W7ZR7023 (Methylprednisolone)
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Anti-Inflammatory Agents/*administration & dosage
MH  - Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/blood/*drug 
      therapy/*mortality
MH  - Azathioprine/administration & dosage
MH  - Cardiovascular Diseases/*mortality
MH  - Comorbidity
MH  - Cyclophosphamide/administration & dosage
MH  - Drug Therapy, Combination
MH  - Female
MH  - Humans
MH  - Immunosuppressive Agents/*administration & dosage
MH  - Infections/*mortality
MH  - Male
MH  - Methylprednisolone/administration & dosage
MH  - Middle Aged
MH  - Recurrence
MH  - Remission Induction
MH  - Renal Dialysis
MH  - Renal Insufficiency/therapy
MH  - Retrospective Studies
MH  - Serum Albumin/metabolism
EDAT- 2014/04/24 06:00
MHDA- 2015/05/12 06:00
CRDT- 2014/04/24 06:00
PHST- 2014/01/28 00:00 [received]
PHST- 2014/04/08 00:00 [accepted]
PHST- 2014/04/24 06:00 [entrez]
PHST- 2014/04/24 06:00 [pubmed]
PHST- 2015/05/12 06:00 [medline]
AID - 10.1007/s11255-014-0717-y [doi]
PST - ppublish
SO  - Int Urol Nephrol. 2014 Aug;46(8):1595-600. doi: 10.1007/s11255-014-0717-y. Epub 
      2014 Apr 23.