Study data published in the Annals of Rheumatic Disease suggest that patients with immunoglobulin A-associated vasculitis (IgAV) are at increased risk for hypertension and chronic kidney disease.
To assess the prevalence of renal disease and hypertension in IgAV, investigators conducted an open retrospective matched cohort study of cardiovascular, venous thrombotic, and renal outcomes in adult-onset and childhood-onset IgAV. Data were extracted from The Health Improvement Network databases, which comprise medical records for 3.6 million active patients around the United Kingdom. Control participants were selected from the same database, and were age- and sex-matched to cases at a 2:1 ratio. Adjusted hazard ratios (aHRs) were calculated using Cox proportional hazards models.
Between 2005 and 2016, incidence of childhood-onset IgAV was 27.22 per 100,000 person-years, and incidence of adult-onset IgAV was 2.20 per 100,000 person-years. Mean age at diagnosis was 6.68 years for children and 38.1 years for adults. Prevalence of both childhood-onset and adult-onset IgAV increased during the study period (2005-2016), although incidence rates remained stable. For the matched cohort study, a total of 2828 patients with adult-onset IgAV and 10,405 patients with childhood-onset IgAV were compared with age- and sex-matched control patients. For the adult-onset cohort, mean age at study entry was 43.3 years for controls and cases, respectively, and 48.4% of participants were men. In the childhood-onset cohort, mean age at study entry was 17.6 years and 53.3% of participants were boys.
Significantly increased risk for hypertension was observed among those with adult-onset (aHR, 1.42; 95% CI, 1.19-1.70) and childhood-onset (aHR, 1.52; 95% CI, 1.22-1.89) IgAV compared with control patients (both P <.001). In addition, IgAV was also associated with substantially increased risk for stage G3 to G5 chronic kidney disease (adult-onset aHR, 1.54; 95% CI, 1.23-1.93; P <.001; childhood-onset aHR, 1.89; 95% CI, 1.16-3.07; P =.010). All-cause mortality was increased in the adult-onset IgAV cohort compared with controls (aHR, 1.27; 95% CI, 1.07-1.50; P =.006). IgAV was not found to be associated with risk for ischemic heart disease, cerebrovascular disease, or venous thromboembolism in either the adult-onset or childhood-onset cohorts.
These data indicate an increased risk for serious hypertensive and renal complications among individuals with IgAV. In addition, those with adult-onset IgAV appear to have increased mortality. Appropriate surveillance of this patient demographic may be necessary to reduce morbidity and mortality and improve long-term outcomes.
Tracy A, Subramanian A, Adderley NJ, et al. Cardiovascular, thromboembolic and renal outcomes in IgA vasculitis (Henoch-Schönlein purpura): a retrospective cohort study using routinely collected primary care data [published online November 28, 2018]. Ann Rheum Dis. doit: 10.1136/annrheumdis-2018-214142