Kidney biopsy in ANCA-associated vasculitis increased intensive immunosuppressive therapy use (RD 28.9%) but was not associated with reduced risk of combined ESKD and death (RD -0.2%).
Does kidney biopsy improve clinical outcomes in patients with AAV with kidney impairment?
In patients with AAV and kidney impairment, performing a kidney biopsy is associated with the use of intensive immunosuppressive therapy but does not significantly improve clinical outcomes such as ESKD or death.
Absolute Event Rate: 0% vs 0%
Introduction: Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) often leads to severe kidney injury and end-stage kidney disease (ESKD) despite treatment.Kidney biopsy is used to assess the severity of kidney lesions caused by AAV.This study aimed to investigate the association of kidney biopsy with intensive immunosuppressive therapy and clinical outcomes in patients with AAV with kidney impairment.Methods: In this retrospective study, propensity score overlap weighting was applied to compare intensive immunosuppressive therapy and clinical outcomes (ESKD, death, combined ESKD and death, and infectious complications) between patients with AAV who underwent kidney biopsy and those who did not.Results: Out of 74 patients with AAV, 38 underwent kidney biopsy.Overlap weight analysis revealed that kidney biopsy was significantly associated with intensive immunosuppressive therapy (risk difference RD, 28.9%; 95% confidence interval CI, 0.017 to 0.562).Kidney biopsy was not associated with combined ESKD and death (RD, -0.2%; 95% CI, -0.302 to 0.298), death (RD, -3.8%; 95% CI, -0.264 to 0.189), ESKD (RD, -7.3%; 95% CI, -0.353 to 0.207), and infectious complications (RD, -25.9%; 95% CI, -0.537 to 0.020).The most common reasons for not performing kidney biopsy were older age, reduced cognitive abilities, and reduced activities of daily living following the use of anticoagulants and/or antiplatelet agents.Conclusion: Kidney biopsy for the assessment of AAV severity contributes to intensive immunosuppression; however, additional clinical benefits to patients with AAV were not detected.It is important to carefully consider which older patients with AAV and multiple comorbidities require biopsy and intensive immunosuppressive therapy.I have no potential conflict of interest to disclose.I did not use generative AI and AI-assisted technologies in the writing process.
Chan et al. (Wed,) reported a other. Kidney biopsy in ANCA-associated vasculitis increased intensive immunosuppressive therapy use (RD 28.9%) but was not associated with reduced risk of combined ESKD and death (RD -0.2%).