(New York, NY – May 12, 2026) – The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (NKF KDOQI) has released a Commentary on the Kidney Disease: Improving Global Outcomes (KDIGO) 2024 Clinical Practice Guideline for the Management of Antineutrophil Cytoplasmic Antibody (ANCA)–Associated Vasculitis. KDOQI Commentaries are designed to help clinicians in the United States interpret and apply international guidelines within the context of the U.S. healthcare system and practice patterns.
ANCA-associated vasculitis (AAV) is a rare but potentially life-threatening group of immune-mediated conditions that frequently involve the kidneys and can lead to rapid kidney failure if not promptly treated. The KDIGO 2024 guideline reflects major advances in the understanding and treatment of AAV, and the KDOQI Commentary provides additional insight on management approaches with different GN histology and clinical phenotypes.
The KDOQI work group broadly agrees with the KDIGO recommendations and highlights several key themes for U.S. clinicians. These include the importance of initiating anti-rejection medicine therapy without delay in patients with rapidly progressive disease, even while awaiting kidney biopsy results; the need for multidisciplinary care at centers experienced in managing vasculitis; and individualized treatment decisions based on disease severity, kidney function, ANCA subtype, and patient preferences.
The Commentary also emphasizes updates in induction and maintenance therapy, including the expanded role of rituximab and the continued use of immunosuppressants in severe kidney disease. In addition, the authors discuss evolving evidence around plasma exchange, relapse risk assessment, and the optimal duration of maintenance therapy. “ANCA-associated vasculitis often presents as a medical emergency for the kidneys,” said lead author Dr. Salem Almaani of the Cleveland Clinic. “This Commentary helps U.S. clinicians translate the KDIGO recommendations into practical decisions that balance the urgency of disease control, optimal immunosuppression regimens, and long-term kidney and survival outcomes.”
Co-authors Dr. Isabelle Ayoub of The Ohio State University and Dr. Duvuru Geetha of Johns Hopkins University noted that access to specialized care, insurance coverage for therapies, and close long-term follow-up remain important challenges in the U.S. “Our goal was to provide clarity where evidence is evolving and to highlight areas where individualized, patient-centered care is essential,” they said.
The KDOQI Commentary also identifies areas in need of future research, including improved biomarkers of disease activity and kidney prognosis, optimal strategies for glucocorticoid minimization, and long-term outcomes with newer therapeutic agents.
The NKF’s KDOQI develops evidence-based clinical practice guidelines and commentaries to improve kidney health and patient outcomes across the United States. To learn more, visit: https://www.ajkd.org/content/kdoqiguidelines
About Kidney Disease
In the United States, CKD remains an under-recognized public health burden that impacts 1 in 7 adults, and 90 percent of those affected are unaware of their condition. Approximately 1 in 3 U.S. adults are at risk for CKD, but less than 20% are assessed with guideline-recommended testing, eGFR and uACR. Risk factors for kidney disease include diabetes, high blood pressure, heart disease, obesity, and family history. People of Black or African American, Hispanic or Latino, American Indian or Alaska Native, Asian American, or Native Hawaiian or Other Pacific Islander descent are at increased risk for developing the disease. Black or African American people are about four times as likely as White people to develop kidney failure. Hispanic and Native American people experience kidney failure at approximately double the rate of White people.
About the National Kidney Foundation
The National Kidney Foundation is revolutionizing the fight to save lives by eliminating preventable kidney disease, accelerating innovation for the dignity of the patient experience, and dismantling structural inequities in kidney care, dialysis, and transplantation. For more information about NKF, visit www.kidney.org.
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Contact:
Sam Tyler
National Kidney Foundation
Director of Professional and Scientific Communications
Phone: 202-279-1505