Ma Y, et al. - In order to determine the effect of intravenous methylprednisolone pulses on renal survival in Chinese anti-neutrophil cytoplasmic autoantibody (ANCA) associated vasculitides (AAV) patients with severe renal involvement, researchers undertook this inquiry. They also investigated the prognostic factors of this treatment in this patient population. They found that in this group of patients, the long-term outcome in term of dialysis independence could be improved with intravenous methylprednisolone pulses and this treatment tended to decrease mortality in these subjects.

Methods

• This study was carried out in a total of 111 AAV patients with an estimated glomerular filtration rate (eGFR) of 10ml/min/1.73 m² or less at admission.
• Intravenous methylprednisolone 500 mg/d for 3 days was given to the MP group (n = 57), but not to the control group (n = 54).
• Both groups were compared in terms of outcomes and adverse events.
• In addition, researchers used Cox regression analysis and ROC curves to analyze predictors for dialysis independence and good response of intravenous methylprednisolone respectively.

Results

• Their median duration of follow-up was 31 (range 3 to 134) months.
• Death of 11 patients in MP group and 20 patients in control group was reported (P=0.056).
• Data showed that 21 patients (36.8%) in MP group and 29 patients (53.7%) in control group were on maintaining dialysis (P=0.088).
• Researchers noted that 21 patients in MP group remained dialysis independent, more than those in control group (4 patients, P <0.01).
• They found that independent risk factors for dialysis independence included urine protein creatinine ratio (hazard ratio 1.730, 95% confidence interval 1.029 to 2.909, P=0.039) and the treatment of intravenous methylprednisolone pulses (hazard ratio 0.362, 95% confidence interval 0.190 to 0.690, P=0.002).
• In addition, they observed that those patients with serum creatinine≥855μmol/L and urine protein ≥3.7g/24h at admission may have worse responses to intravenous methylprednisolone pulses (sensibility 56.7%, specificity 85.0%, PPV 100.0% and NPV57.1%).