Mortality in Patients With IgA Nephropathy

Knoop, Thomas; Vikse, Bjørn Egil; Svarstad, Einar; Leh, Sabine; Reisæter, Anna Varberg; Bjørneklett, Rune

doi:10.1053/j.ajkd.2013.04.019

Cited by 53 publications

(63 citation statements)

References 27 publications

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“…Our findings are not surprising given the facts that proteinuria, hypertension, initial eGFR, and histopathological lesions are the four best documented traditional risk markers for progression to ESRD [4,5,6,17] and death in IgAN patients [21]. In principle, all prognostic models should be tested on populations that are independent of the cohort used to develop the models [16].…”

Section: Discussionmentioning

confidence: 99%

“…In the French study, 32 ESRD and 13 deaths [14] were observed, compared to 251 ESRD and 69 deaths as observed in the present work. Furthermore, our group recently demonstrated that the mortality rate of IgAN patients with initial eGFR in the normal range is not increased compared to the general population adjusted for age and sex [21]. Thus, it may be disputable whether including deaths as an endpoint in the ARR model is appropriate, particularly when applied for patients with eGFR ≥60 ml/min/1.73 m 2 .…”

Section: Discussionmentioning

confidence: 99%

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Addition of eGFR and Age Improves the Prognostic Absolute Renal Risk-Model in 1,134 Norwegian Patients with IgA Nephropathy

et al. 2015

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Background: Predicting outcome in individual patients with IgA nephropathy (IgAN) is difficult but important. For this purpose, the absolute renal risk (ARR) model has been developed in a French cohort to calculate the risk of end-stage renal disease (ESRD) and death. ARR (0-3) is scored in individual IgAN patients based on the presence of proteinuria ≥1 g/24 h, hypertension, and severe histopathological lesions (1 point per risk factor). We have validated the ARR model in a Norwegian cohort of IgAN patients and tested whether adding data on initial estimated glomerular filtration rate (eGFR) and age improved prediction. Methods: IgAN patients diagnosed between 1988 and 2012 were identified in the Norwegian Kidney Biopsy Registry, and endpoints were identified by record linkage with the Norwegian Renal Registry (ESRD) and the Population Registry (deaths). Results: We identified 1,134 IgAN patients. The mean duration of follow-up was 10.2 years (range 0.0 to 25.7 years). Two hundred and fifty one patients developed ESRD and there were 69 pre-ESRD deaths. The ARR model significantly stratified the IgAN cohort according to risk of ESRD/death. The inclusion of eGFR and age significantly improved the ARR prognostic model; in the receiver operator characteristics (ROC) analysis, area under the curve (AUC) at 10-years of follow-up increased from 0.79 to 0.89, p < 0.001. Conclusions: ARR is a suitable prognostic model for stratifying IgAN patients according to the risk of ESRD or death. Including initial eGFR and age in the model substantially improved its accuracy in our nationwide cohort.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Addition of eGFR and Age Improves the Prognostic Absolute Renal Risk-Model in 1,134 Norwegian Patients with IgA Nephropathy

et al. 2015

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“…Among patients with biopsy-proven IgAN, 15%-20% reach ESRD within 10 years and 20%-40% by 20 years (7). Mortality in patients with IgAN correlates with GFR, although in contrast to other forms of CKD the risk of ESRD is substantially higher than the risk of death (8).…”

Section: Introductionmentioning

confidence: 99%

Glomerular Diseases

Canetta

Kiryluk

Appel

2014

Clinical Journal of the American Society of Nephrology

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SummaryThe last decade has seen major progress in understanding the pathogenesis as well as the prognosis and treatment of patients with IgA nephropathy (IgAN). Although the diagnostic criterion of a kidney biopsy demonstrating dominant or codominant IgA deposition remains unchanged, much more is known about the genetic and environmental factors predisposing to disease development and progression. These advances have led to the identification of novel diagnostic and prognostic markers. Among the most promising clinically are genetic profiling, quantification of galactose-deficient IgA1 levels, and measurement of anti-IgA1 immunoglobulins. While targeted treatment for IgAN remains elusive, there is mounting evidence for therapeutic interventions that alter the disease course. The appropriate validation and integration of these discoveries into clinical care represent a major challenge, but one that holds tremendous promise for refining prognostication, guiding therapy, and improving the lives of patients with IgAN.

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“…Treatment of patients with ESRD caused by GN incurs an estimated annual cost to Medicare alone of almost $3 billion (1). Mortality in GN increases dramatically after the onset of ESRD (2)(3)(4)(5); however, the relative contributions from generic ESRD-related factors and from the underlying cause of GN to this finding have not formally been evaluated.…”

Section: Introductionmentioning

confidence: 99%

Patient Characteristics and Outcomes by GN Subtype in ESRD

O’Shaughnessy

Montez‐Rath

Lafayette

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Outcomes-based research rarely focuses on patients with ESRD caused by GN. The hypotheses were that the GN subtype would clinically discriminate patient groups and independently associate with survival after ESRD therapy initiation.Design, setting, participants, & measurements Data were extracted from the US Renal Data System for adult patients with incident (1996-2011) ESRD attributed to six GN subtypes: FSGS, IgA nephropathy (IgAN), membranous nephropathy, membranoproliferative glomeruonephritis, lupus nephritis (LN), and vasculitis. ESRD attributed to diabetes and autosomal dominant polycystic kidney disease served as non-GN comparators. Unadjusted and adjusted mortality hazard ratios (aHRs) with 95% confidence intervals (95% CIs) were estimated using Cox regression (reference, IgAN). Models sequentially adjusted for sociodemographic (model 2), comorbidity/laboratory (model 3), and ESRD treatment modality (model 4) variables.Results Among 84,301 patients with ESRD attributed to GN, the median age ranged from 39 (LN) to 66 (vasculitis) years, male sex ranged from 18% (LN) to 68% (IgAN), and black race ranged from 7% (IgAN) to 49% (LN). Patients with IgAN had the fewest comorbidities and lowest use of hemodialysis (70.1%). After a median followup of 2.5 (interquartile range, 1.0-4.9) years, crude mortality was lowest in IgAN (3.7 deaths/100 person years). Compared to IgAN, adjusted mortality was highest in LN (model 4 aHR=1.75; 95% CI, 1.68 to 1.83) and in diabetes (aHR=1.73; 95% CI, 1.67 to 1.79), and was also higher in all other GN subtypes (membranous nephropathy: aHR=1.23; 95% CI, 1.17 to 1.29; FSGS: aHR=1.37; 95% CI, 1.32 to 1.42; membranoproliferative GN: aHR=1.38; 95% CI, 1.31 to 1.45; vasculitis: aHR=1.51; 95% CI, 1.45 to 1.58) and in autosomal dominant polycystic kidney disease (aHR=1.22; 95% CI, 1.18 to 1.27).Conclusions This study exposes substantial heterogeneity across GN subtypes at ESRD therapy initiation and identifies independent associations between GN subtype and post-ESRD mortality. These survival discrepancies warrant further study, and the utility of current research practice to group GN subtypes together when evaluating ESRD outcomes should be questioned.

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Mortality in Patients With IgA Nephropathy

Cited by 53 publications

References 27 publications

Addition of eGFR and Age Improves the Prognostic Absolute Renal Risk-Model in 1,134 Norwegian Patients with IgA Nephropathy

Addition of eGFR and Age Improves the Prognostic Absolute Renal Risk-Model in 1,134 Norwegian Patients with IgA Nephropathy

Glomerular Diseases

Patient Characteristics and Outcomes by GN Subtype in ESRD

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