Hemoglobin levels predict the course of AAV-related kidney disease | Low blood levels associated with a stay in intensive care | Tech US News


A stay in intensive care is more likely when levels of oxygen-carrying hemoglobin are low at hospital admission in adults with kidney disease caused by ANCA-associated vasculitis (AAV), an analysis of medical records shows.

Severe kidney injury was the main reason for intensive care unit (ICU) admission in these patients and was associated with renal replacement therapy (KRT), a life-sustaining procedure that replaces the kidney’s role in removing waste and excess fluid from the blood.

These findings help understand the role of hemoglobin in AAV-related kidney disease, her scientists noted.

study, “Low hemoglobin levels are associated with critical illness and predict disease course in patients with ANCA-associated renal vasculitis,” was published in the magazine Nature Scientific Reports.

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A person drinks a glass of water, which is important for the proper functioning of the kidneys, which is emphasized here.

Renal involvement is found in up to half of patients with AAV

Renal or renal involvement occurs in up to 50% of patients with AAV at disease onset and is a serious complication of AAV that causes acute kidney injury that progresses to CKD. While current treatment can lead to disease remission in up to 80% of cases, some patients do not respond and may require support in the renal intensive care unit.

However, data on patients with AAV admitted to ICU due to renal involvement as a major complication of AAV are limited, with most studies focusing on long-term renal and overall outcomes. In particular, data on critical illness during the initial course of the disease are scarce.

Researchers at the University Medical Center Göttingen in Germany reviewed the medical records of 53 patients to identify predictors of critical illness in those with AAV-related renal vasculitis.

The participants were 30 men and 23 women, with a median age at diagnosis of 65 years (range, 54.5 to 74.5). Approximately half (49.1%) were diagnosed with microscopic polyangiitis (MPA) and the remainder with granulomatosis with polyangiitis (GPA), both subtypes of AAV, with a new diagnosis of AAV-related renal involvement in most cases.

CRT was required in 16 patients (30.2%) within 30 days of hospital admission, but none required mechanical ventilation for respiratory failure. Twenty-four patients (45.3%) received ICU supportive care, with a median ICU stay of four days and an ICU mortality rate of 12.5%.

The median four-day intensive care stay for kidney involvement was shorter than most previous reports focusing on critical illness from AAV-related lung involvement, the team found.

Critical illness due to AAV-associated severe renal disease was confirmed, and all 53 individuals underwent diagnostic renal biopsy. Most patients (83%) had manifestations of the disease outside the kidney, including the lungs, sinuses, joints, ears, eyes, nerves, and skin.

Compared with those who did not require an ICU stay, patients who required an ICU stay were similar in terms of age, gender, AAV subtypes, disease recurrence, disease activity, or additional involvement.

As shown by KRT within 30 days of admission, the risk of severe kidney injury was significantly higher in patients who required intensive care than in those who did not. The hospital stay was also significantly longer in patients who required intensive care. The use of AAV therapies, such as steroids and plasma exchange, aimed at reducing circulating levels of disease-causing antibodies, was significantly more common in the intensive care group.

The researchers concluded that severe kidney injury was the main reason for ICU admission and was associated with CRT during the course of the disease. Critical illness due to renal failure has led to increased use of plasma exchange and pulse steroid therapy.

Low hemoglobin levels are independently associated with ICU admission

Next, the team reviewed tests at hospital admission to identify factors associated with a possible intensive care stay.

Markers of kidney damage, including blood creatinine levels, decreased eGFR, and protein levels in the urine, were significantly higher in the intensive care group, as were levels of C-reactive protein, a marker of inflammation, and gamma-glutamyl transferase, an indicator of liver damage.

Hemoglobin, a protein that carries oxygen in red blood cells, and hematocrit — the proportion of red blood cells in the bloodstream — were both significantly lower in those admitted to intensive care.

Statistical analysis showed that low hemoglobin levels were independently associated with eventual ICU admission. Further calculations significantly associated a hemoglobin level below 9.8 grams per deciliter of blood (g/dL) with admission to intensive care. For reference, a normal hemoglobin level ranges between 14.0-17.5 g/dl for men and 12.3-15.3 g/dl for women.

A hemoglobin level below 9.8 g/dL on admission was also associated with a longer hospital stay compared with hemoglobin levels above this limit (median 25 vs 12.5 days). Notably, low hemoglobin was associated with a longer ICU stay in the ICU group (median six versus three days), but not for total hospital stay in the ICU or no ICU group.

“These results confirm that low hemoglobin levels on admission are associated with critical illness and the need for supportive care in the intensive care unit, but also predict disease course specifically in this subgroup of severe ANCA-associated renal vasculitis,” the scientists wrote.

“Since the identification of patients at risk of a more severe disease course is important for intensivist management, these findings could further improve our current understanding of the role of anemia in ANCA-associated renal vasculitis, as already observed in other autoimmune and inflammatory diseases,” they added. .


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