The Association of Low Hemoglobin Levels with IgA Nephropathy Progression: A Two-Center Cohort Study of 1,828 Cases

Zhu, Bin; Liu, Wenhua; Yu, Dongrong; Lin, Yi; Li, Qiang; Tong, Mengli; Li, Yayu; Yang, Rei‐Cheng; Du, Yuanyuan; Tang, Xin; Jiang, Fei; Fei, Dan; Wei, Xinyi; Zhang, Feifei; Yin, Jianwei; Wang, Wen-Rong; Li, Xianfa; Sun, Yue; Zhong, Yong-Zhong; Zhang, Mei-Juan; Cheng, Xin; Zhu, Changlian; Chen, Hongyu

doi:10.1159/000508770

Cited by 14 publications

(12 citation statements)

References 42 publications

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“…This pathway is related to podocyte injury and promotion of proteinuria [18,36]. In addition, the relationship between anemia and pathological changes in renal tubulointerstitium has been reported [37,38]. Anemia-induced hypoxic injury on the glomerulus and the tubulointerstitium might explain the association of anemia with poor renal prognosis in patients with IgA nephropathy.…”

Section: Discussionmentioning

confidence: 97%

The Association between Serum Hemoglobin and Renal Prognosis of IgA Nephropathy

Song

Choi

et al. 2021

JCM

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Immunoglobin A (IgA) nephropathy causes chronic kidney disease worldwide. Therefore, identifying risk factors associated with the progression of IgA nephropathy is crucial. Anemia is a common complication of chronic kidney disease; however, few studies have investigated the effect of serum hemoglobin on the renal prognosis of IgA nephropathy. This study aimed to determine the effect of serum hemoglobin on the progression of IgA nephropathy. We retrospectively analyzed 4326 patients with biopsy-proven IgA nephropathy. We evaluated the effect of serum hemoglobin on IgA nephropathy progression using Kaplan–Meier survival analyses, the log-rank test, and the Cox proportional hazards model. The primary end-point was progression of IgA nephropathy, defined as dialysis initiation or kidney transplantation. Serum hemoglobin showed a nonlinear relationship with the progression of IgA nephropathy. The Cox proportional hazards model showed that the risk of progression of IgA nephropathy decreased 0.87 times for every 1.0 g/dL increase in serum hemoglobin. In subgroup analyses, reduced serum hemoglobin was an independent risk factor for IgA nephropathy progression only in women. There was no statistically significant interaction of serum hemoglobin between men and women (Pinteraction = 0.177). Results of Sensitivity analysis were robust and consistent. Serum hemoglobin at diagnosis was an independent predictor for IgA nephropathy progression.

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Section: Discussionmentioning

confidence: 97%

The Association between Serum Hemoglobin and Renal Prognosis of IgA Nephropathy

Song

Choi

et al. 2021

JCM

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“…Serum albumin is closely related to urinary protein excretion and also it was reported as an independent risk factor of prognosis of IgAN ( 21 ). Anemia and AS may also have a synergistic effect on chronic renal hypoxia and contribute to the progression of the disease ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

Arterial-Arteriolar Sclerosis Is Independently Associated With Poor Renal Outcome in IgA Nephropathy Patients

Dong

Tan

et al. 2021

Front. Med.

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Aim: This study aimed to investigate the clinicopathological features and prognosis of immunoglobulin A nephropathy (IgAN) with arterial-arteriolar sclerosis (AS).Methods: Patients with biopsy-proven IgAN from the West China Hospital of Sichuan University were retrospectively enrolled. Clinicopathological features were collected. Patients were categorized based on the presence and the severity of the AS. All the patients were regularly followed-up until a composite end point. The correlation between AS and prognosis of IgAN was assessed.Results: A total of 1,424 patients were recruited and followed for 60.0 ± 28.7 months. Patients with AS tended to have older age, higher blood pressure, heavier proteinuria, higher serum creatinine, uric acid, and total triglyceride (TG). Meanwhile, they were more likely to have a lower estimated glomerular filtration rate (eGFR), hemoglobin, and albumin. At the end of follow-up, 126 patients in the AS group and 47 patients in the non-AS group had reached the composite end point (p < 0.001). AS was associated with the renal outcome (log-rank p < 0.001) and was an independent risk factor for the progression of IgAN (p = 0.049). The severity of AS was associated with renal outcomes (log-rank p < 0.001) and there was a trend that it might serve as an independent risk marker for progression of IgAN. In the subgroup analysis, patients presenting with AS and lower eGFR, albumin, and hemoglobin or higher proteinuria, uric acid, and TG had a significant trend for a shorter time to reach the end point (log-rank p < 0.001).Conclusion: AS was commonly seen in patients with IgAN and was independently associated with the poor prognosis.

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“…Journal of Immunology Research along with unadjusted and adjusted Cox proportional hazards models, were used to analyze the relationship between serum chloride level and the prognosis of patients with IgAN. Age, sex, hypertension, 24 h-UTP, sCr, and Oxford classification scores were adjusted in multivariable-adjusted Cox proportional hazards models [20][21][22][23]. Furthermore, we built a predictive model for prognosis.…”

Section: Methodsmentioning

confidence: 99%

“…Our reasons for choosing these indicators were as follows. Firstly, in clinical research, age and gender need to be adjusted initially in the Cox proportional hazards model, irrespective of whether there are significant differences or not [20][21][22][23]. Secondly, hypertension, 24 h-UTP, sCr, and Oxford classification scores have been proven to be vital risk factors for the prognosis of patients with IgAN [20][21][22][23].…”

Section: Experimental Grouping Based On Serum Chloride Levelsmentioning

confidence: 99%

“…Firstly, in clinical research, age and gender need to be adjusted initially in the Cox proportional hazards model, irrespective of whether there are significant differences or not [20][21][22][23]. Secondly, hypertension, 24 h-UTP, sCr, and Oxford classification scores have been proven to be vital risk factors for the prognosis of patients with IgAN [20][21][22][23]. When adjusted for sex, age, sCr, 24 h-UTP, hypertension, and Oxford classification scores, a serum chloride level ≥ 105:4 mmol/L still showed a significant association with a poor renal outcome in patients with IgAN (model 1: HR, 3.09; 95% CI, 1.69-5.64, p < 0:001; model 2: HR, 2.33; 95% CI, 1.20-4.55, p = 0:01; model 3: HR, 2.05; 95% CI, 1.03-4.07, p = 0:04).…”

Section: Experimental Grouping Based On Serum Chloride Levelsmentioning

confidence: 99%

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Elevated Serum Chloride Levels Contribute to a Poor Prognosis in Patients with IgA Nephropathy

Zhai

Yao

et al. 2021

Journal of Immunology Research

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Introduction. The identification of reliable prognostic factors is a crucial requirement for patients with IgA nephropathy (IgAN). Here, we explored the relationship between serum chloride levels and prognosis in patients with IgAN. Methods. We recruited all patients with primary IgAN, as diagnosed by renal biopsy, between 1st January 2015 and 1st April 2019. Patients were divided two groups (high chloride group and low chloride group) based on the best cut-off values from survival receiver operating characteristic (ROC) curves. The baseline clinicopathological characteristics of two groups were then compared. Cox proportional hazard models were used to determine the prognostic value of serum chloride levels in patients with IgAN. Finally, we screened reliable prognostic indicators and built a clinical prediction model and validated the performance of the model. Results. Compared with patients in the high chloride group, patients in the low chloride group had significantly lower levels of 24-hour urinary total protein (24 h-UTP), serum creatinine (sCr), and higher levels of hemoglobin (Hb), albumin (all p < 0.05 ), and less proportion of Oxford classification grade E1 (endothelial cell proliferation) and T2 (renal tubule atrophy or renal interstitial fibrosis). Cox analysis revealed that serum chloride level ≥ 105.4 mmol / L was a significant and independent risk factor for prognosis in patients with IgAN ( p < 0.05 ). Serum chloride, sCr, T, hypertension, and Hb were used to generate a predictive model for prognosis. The c -indices of our predictive model were 0.80, 0.86, and 0.78, for 1, 2, and 3 years, respectively; Brier scores were 0.06, 0.09, and 0.16, respectively. Conclusions. A serum chloride level ≥ 105.4 mmol / l was identified as a significant and independent risk factor for the prognosis of patients with IgAN. A predictive prognosis model was generated using serum chloride, sCr, T, hypertension, and Hb; this model exhibited a good predictive effect.

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The Association of Low Hemoglobin Levels with IgA Nephropathy Progression: A Two-Center Cohort Study of 1,828 Cases

Cited by 14 publications

References 42 publications

The Association between Serum Hemoglobin and Renal Prognosis of IgA Nephropathy

The Association between Serum Hemoglobin and Renal Prognosis of IgA Nephropathy

Arterial-Arteriolar Sclerosis Is Independently Associated With Poor Renal Outcome in IgA Nephropathy Patients

Elevated Serum Chloride Levels Contribute to a Poor Prognosis in Patients with IgA Nephropathy

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