#3882 Prognostic factors for cardiovascular events in pauci-immune glomerulonephritis: a retrospective cohort study

Abstract Background and Aims Pauci-immune glomerulonephritis is a severe form of renal vasculitis, often associated with ANCA positivity and multisystem involvement. Small-vessel vasculitis is an increasingly recognized risk factor for cardiovascular disease. Our study aimed to identify potential prognostic factors associated with cardiovascular events at the time of diagnosis. Method We conducted a retrospective cohort study including data of all patients with biopsy-proven PIGN who were followed at our center between 1999 and 2024, with a minimum follow-up period of six months. Cardiovascular events were defined as myocardial ischemia, stroke, congestive heart failure (CHF), atrial fibrillation (AF), and pericarditis. Univariate and multivariate Cox regression analyses were used to assess the relationship between potential risk factors at diagnosis and adverse cardiovascular outcomes. Results A total of 88 patients (male 53.4%) with a median age of 63 years (IQR 53 –70) at renal diagnosis were included in the study. Among traditional risk factors examined at presentation, hypertension, diabetes mellitus (DM), and previous history of cardiovascular disease (CVD) were present in 44.3%, 15.9% and 10.2% of the participants, respectively. Twenty patients (22.7%) were dialysis-dependent at the time of kidney biopsy. MPO-ANCA were the most prevalent type (54.5%). Crescentic and sclerotic classes were observed in 24.7% and 10.4% of the individuals, respectively. The median Birmingham Vasculitis Activity Score (BVAS) was 15 (IQR 12–19). Cyclophosphamide was administered to 81.8%, rituximab to 69.3% and therapeutic plasma exchange to 34.1% of the patients. Over a median follow-up period of 62 months (IQR 29–133), 26 patients (29.5%) developed cardiovascular events. Nine of those events (36%) were observed during the first 12 months from diagnosis. Acute myocardial ischemia occurred in 15.4%, stroke in 3.8%, CHF in 34.6 %, AF in 38.4% and pericarditis in 7.7% of them. Univariate Cox regression analysis identified age, hypertension and BVAS at diagnosis as prognostic factors for cardiovascular events in our cohort. In multivariate Cox regression model adjusted for age, sex, hypertension, DM, CVD, hemodialysis at diagnosis, ANCA type and BVAS, the presence of hypertension (HR: 4.38, 95% CI: 1.40–13.69, p-value: 0.011) and higher BVAS at presentation (HR: 1.15, 95%CI: 1.00–1.32, p-value: 0.046) were recognized as risk factors for cardiovascular events. Conclusion Cardiovascular events were common in patients with pauci-immune glomerulonephritis in our cohort, with a considerable proportion of them occurring within the first year of diagnosis. Hypertension and higher disease activity at presentation were identified as independent predictors of adverse cardiovascular outcomes.