Older Patients Have Worse Mortality, but Treatment Helps All Ages
People over the age of 65 with ANCA-associated vasculitis (AAV) have worse mortality outcomes than younger patients, but kidney failure is not greater in this group, according to a recent study.
These worse outcomes were associated with lower levels of hemoglobin — the protein responsible for carrying oxygen in the blood — and with higher serum creatinine at the time of diagnosis, which is indicative of worse kidney function.
However, treating patients with oral cyclophosphamide, a cancer therapy, and steroids decreased mortality rates among both older and younger patients, the study found.
The study, “Clinical features and outcomes of elderly patients with antineutrophil cytoplasmic antibody-positive vasculitis: a single-center retrospective study,” was published in Kidney Research and Clinical Practice.
Although AAV is known to mostly occur in people over the age of 65, appropriate treatment strategies that reduce mortality and the progression of kidney disease have not been properly established in this population.
This is mainly because the disease is treated with corticosteroids and immunosuppressant medications, which are known to pose significant risks to patients, particularly older ones.
“In elderly patients, decreased immunity and the increased risk of infection are of great concern in immunosuppressant treatment,” the researchers wrote.
To learn more about treating patients both over and under age 65, researchers in Korea now set out to investigate demographic factors, different treatments, and outcomes among people with AAV in their country. Specifically, the team sought to compare characteristics and outcomes among older and younger patients.
The primary goal was to determine the mortality rate from all causes, and causes of death, while the secondary outcome was kidney failure or a need for dialysis versus kidney recovery, or dialysis cessation.
The study included 70 people with AAV who tested positive for ANCA antibodies and were followed at the Pusan National School of Medicine from 2006 to 2019. Patients were mostly male (64.3%), with a mean age of 62.8, and had antibodies against the MPO protein (74.3%).
Overall, the group included 34 patients who were younger than 65, and 36 who were age 65 or over. The average age of the older group was 72.2, with the oldest patient age 83, while the younger individuals had a mean age of 52.9 years.
The two age groups were fairly similar in their characteristics, but the over-65 patients had significantly lower hemoglobin and serum albumin levels, and a significantly higher C-reactive protein, which was indicative of increased inflammation.
Older patients also more frequently received oral cyclophosphamide as an induction treatment, while younger ones were more often treated with into-the-vein cyclophosphamide. Nearly one in five patients over 65 (19.4%) were not receiving any treatment.
Over a median follow-up period of 14.6 months, 13 people died — two in the younger group and 11 in the older group. Infection was the major cause of death, occurring in 61.5% of patients; all those who died had pneumonia.
The number of deaths was significantly higher in the seniors group than in the younger group. Among those who did not receive initial induction treatment, three out of seven died within 75 days (about 2.5 months) due to pneumonia.
An additional analysis of factors associated with all-cause mortality found that older age and lower hemoglobin levels were significant risk factors in the overall population, while treatment with oral cyclophosphamide and steroids was a protective factor.
Similar results were seen in the over-65 group when taken alone, with the addition of higher serum creatinine — indicative of decreased kidney function — as a risk factor for all-cause mortality.
These results may indicate that “immunosuppressants can be used with caution in elderly patients with AAV, with careful monitoring for adverse events,” the team wrote.
Over the follow-up period, nine of the 48 individuals not initially on dialysis started it, and four of the 22 initially on dialysis stopped that treatment. However, the results showed no differences in kidney outcomes among younger and older patients, the researchers noted.
Overall, patients ages 65 years or older “had higher mortality rates than younger patients, which was associated with older age, lower hemoglobin, higher serum creatinine, and nontreatment compared to oral [cyclophosphamide plus steroids],” the researchers concluded.