February 20, 2024

[Brussels, Belgium] Kidney Disease: Improving Global Outcomes (KDIGO) is pleased to announce the publication of the KDIGO 2024 Clinical Practice Guideline for the Management of Antineutrophilic Cytoplasmic Antibody (ANCA)-Associated Vasculitis, published today in the March issue of Supplement to Kidney International, with an Executive Summarypublished in the main pages of the journal. Developed under the stewardship of Co-Chairs Brad Rovin, MD (United States) and Jürgen Floege, MD (Germany), this guideline is an update of the ANCA Vasculitis chapter of the KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases.

The guideline provides updated recommendations and practice points based on evidence from randomized controlled trials published since July 2022. Avacopan received regulatory approval in late 2021, which was the trigger for this guideline update. In addition, there is new evidence supporting a lower-dose glucocorticoid induction regimen or even a complete replacement of glucocorticoids. Lastly, the guideline also addresses therapies like plasma exchange for use in patients with advanced kidney disease.

The development of the guideline followed an explicit process of evidence review and appraisal. Treatment approaches and guideline recommendations were based on systematic reviews of relevant studies. Appraisal of the certainty of the evidence and the strength of recommendations followed the ‘Grading of Recommendations Assessment, Development and Evaluation’ (GRADE) approach. Recommendations are graded based on the strength of the recommendation and certainty of evidence, while practice points serve as expert guidance to complement these recommendations. Limitations of the evidence are discussed, with areas for future research also presented. As part of KDIGO’s transparent guideline development process, the draft guideline was made available for public comment in May 2023, receiving valuable feedback, which was meticulously reviewed and considered by the Guideline Work Group.

“The ANCA Vasculitis Guideline includes significant updates aimed at enhancing clinical decision-making, integrating new treatments with established clinical practices,” stated Dr. Floege. “We anticipate that the comprehensive research, clinical perspectives, and collaborative expertise reflected in this guideline will contribute to better outcomes for individuals grappling with this complex condition.”

“We are excited to release the KDIGO 2024 ANCA Vasculitis Guideline, which offers new guidance for managing the intricacies of ANCA vasculitis treatment, particularly with the emergence of innovative therapies,” said Dr. Rovin. “We are better equipped than ever to tailor interventions, optimize patient care, and strive towards improved outcomes for people with ANCA-associated vasculitis.”

KDIGO thanks the Guideline Work Group for their dedication and expertise and the Evidence Review Team from Brown University School of Public Health for their comprehensive work on this guideline.