Loading…
Long-Term Outcomes in IgA Nephropathy
IgA nephropathy can progress to kidney failure, and risk assessment soon after diagnosis has advantages both for clinical management and the development of new therapeutics. We present relationships among proteinuria, eGFR slope, and lifetime risks for kidney failure. The IgA nephropathy cohort (229...
Saved in:
| Published in: | Clinical journal of the American Society of Nephrology 2023-06, Vol.18 (6), p.727-738 |
|---|---|
| Main Authors: | , , , , , , , , , , , |
| Format: | Article |
| Language: | English |
| Subjects: | |
| Citations: | Items that this one cites Items that cite this one |
| Online Access: | Get full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| cited_by | cdi_FETCH-LOGICAL-c353t-455ddb19ef8a73d110ceec2c465c425aea0573077ae546aa27621a9e5535116c3 |
|---|---|
| cites | cdi_FETCH-LOGICAL-c353t-455ddb19ef8a73d110ceec2c465c425aea0573077ae546aa27621a9e5535116c3 |
| container_end_page | 738 |
| container_issue | 6 |
| container_start_page | 727 |
| container_title | Clinical journal of the American Society of Nephrology |
| container_volume | 18 |
| creator | Pitcher, David Braddon, Fiona Hendry, Bruce Mercer, Alex Osmaston, Kate Saleem, Moin A Steenkamp, Retha Wong, Katie Turner, A Neil Wang, Kaijun Gale, Daniel P Barratt, Jonathan |
| description | IgA nephropathy can progress to kidney failure, and risk assessment soon after diagnosis has advantages both for clinical management and the development of new therapeutics. We present relationships among proteinuria, eGFR slope, and lifetime risks for kidney failure.
The IgA nephropathy cohort (2299 adults and 140 children) of the UK National Registry of Rare Kidney Diseases (RaDaR) was analyzed. Patients enrolled had a biopsy-proven diagnosis of IgA nephropathy plus proteinuria >0.5 g/d or eGFR |
| doi_str_mv | 10.2215/CJN.0000000000000135 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2801982142</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2801982142</sourcerecordid><originalsourceid>FETCH-LOGICAL-c353t-455ddb19ef8a73d110ceec2c465c425aea0573077ae546aa27621a9e5535116c3</originalsourceid><addsrcrecordid>eNpdkE1PwkAQhjdGI4j-A2N6MfFS3Nnd6dIjIX5gGrhg4m2zbAeoaWndbQ_8ezEgMc7lncP7kTyM3QIfCgH4OHmbDfnfA4lnrA-IGKccP85Pv4Ieuwrhk3OlpMBL1pOaI0KKfXaf1dt1vCBfRfOudXVFISq20XQ9jmbUbHzd2Hazu2YXK1sGujnqgL0_Py0mr3E2f5lOxlnsJMo2Voh5voSUViOrZQ7AHZETTiXolEBLlqOWXGtLqBJrhU4E2JQQJQIkTg7Yw6G38fVXR6E1VREclaXdUt0FI0Yc0pEAJfZWdbA6X4fgaWUaX1TW7wxw8wPI7AGZ_4D2sbvjQresKD-FfonIb8VzXgQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2801982142</pqid></control><display><type>article</type><title>Long-Term Outcomes in IgA Nephropathy</title><source>PMC (PubMed Central)</source><source>American Society of Nephrology</source><creator>Pitcher, David ; Braddon, Fiona ; Hendry, Bruce ; Mercer, Alex ; Osmaston, Kate ; Saleem, Moin A ; Steenkamp, Retha ; Wong, Katie ; Turner, A Neil ; Wang, Kaijun ; Gale, Daniel P ; Barratt, Jonathan</creator><creatorcontrib>Pitcher, David ; Braddon, Fiona ; Hendry, Bruce ; Mercer, Alex ; Osmaston, Kate ; Saleem, Moin A ; Steenkamp, Retha ; Wong, Katie ; Turner, A Neil ; Wang, Kaijun ; Gale, Daniel P ; Barratt, Jonathan</creatorcontrib><description>IgA nephropathy can progress to kidney failure, and risk assessment soon after diagnosis has advantages both for clinical management and the development of new therapeutics. We present relationships among proteinuria, eGFR slope, and lifetime risks for kidney failure.
The IgA nephropathy cohort (2299 adults and 140 children) of the UK National Registry of Rare Kidney Diseases (RaDaR) was analyzed. Patients enrolled had a biopsy-proven diagnosis of IgA nephropathy plus proteinuria >0.5 g/d or eGFR <60 ml/min per 1.73 m 2 . Incident and prevalent populations and a population representative of a typical phase 3 clinical trial cohort were studied. Analyses of kidney survival were conducted using Kaplan-Meier and Cox regression. eGFR slope was estimated using linear mixed models with random intercept and slope.
The median (Q1, Q3) follow-up was 5.9 (3.0, 10.5) years; 50% of patients reached kidney failure or died in the study period. The median (95% confidence interval [CI]) kidney survival was 11.4 (10.5 to 12.5) years; the mean age at kidney failure/death was 48 years, and most patients progressed to kidney failure within 10-15 years. On the basis of eGFR and age at diagnosis, almost all patients were at risk of progression to kidney failure within their expected lifetime unless a rate of eGFR loss ≤1 ml/min per 1.73 m 2 per year was maintained. Time-averaged proteinuria was significantly associated with worse kidney survival and more rapid eGFR loss in incident, prevalent, and clinical trial populations. Thirty percent of patients with time-averaged proteinuria of 0.44 to <0.88 g/g and approximately 20% of patients with time-averaged proteinuria <0.44 g/g developed kidney failure within 10 years. In the clinical trial population, each 10% decrease in time-averaged proteinuria from baseline was associated with a hazard ratio (95% CI) for kidney failure/death of 0.89 (0.87 to 0.92).
Outcomes in this large IgA nephropathy cohort are generally poor with few patients expected to avoid kidney failure in their lifetime. Significantly, patients traditionally regarded as being low risk, with proteinuria <0.88 g/g (<100 mg/mmol), had high rates of kidney failure within 10 years.</description><identifier>ISSN: 1555-9041</identifier><identifier>EISSN: 1555-905X</identifier><identifier>DOI: 10.2215/CJN.0000000000000135</identifier><identifier>PMID: 37055195</identifier><language>eng</language><publisher>United States</publisher><subject>Adult ; Child ; Disease Progression ; Glomerular Filtration Rate ; Glomerulonephritis, IGA - complications ; Glomerulonephritis, IGA - epidemiology ; Humans ; Kidney ; Kidney Failure, Chronic - therapy ; Proteinuria - etiology ; Retrospective Studies</subject><ispartof>Clinical journal of the American Society of Nephrology, 2023-06, Vol.18 (6), p.727-738</ispartof><rights>Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Nephrology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c353t-455ddb19ef8a73d110ceec2c465c425aea0573077ae546aa27621a9e5535116c3</citedby><cites>FETCH-LOGICAL-c353t-455ddb19ef8a73d110ceec2c465c425aea0573077ae546aa27621a9e5535116c3</cites><orcidid>0000-0002-7950-7685 ; 0000-0003-3019-6369 ; 0000-0003-3448-5651 ; 0000-0002-9170-1579 ; 0009-0006-5279-1416 ; 0000-0003-4547-873 ; 0000-0002-9175-9236 ; 0009-0006-5356-758 ; 0009-0001-6625-0737 ; 0000-0002-9808-4518 ; 0009-0006-5356-758X ; 0000-0003-4547-873X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,4011,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37055195$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pitcher, David</creatorcontrib><creatorcontrib>Braddon, Fiona</creatorcontrib><creatorcontrib>Hendry, Bruce</creatorcontrib><creatorcontrib>Mercer, Alex</creatorcontrib><creatorcontrib>Osmaston, Kate</creatorcontrib><creatorcontrib>Saleem, Moin A</creatorcontrib><creatorcontrib>Steenkamp, Retha</creatorcontrib><creatorcontrib>Wong, Katie</creatorcontrib><creatorcontrib>Turner, A Neil</creatorcontrib><creatorcontrib>Wang, Kaijun</creatorcontrib><creatorcontrib>Gale, Daniel P</creatorcontrib><creatorcontrib>Barratt, Jonathan</creatorcontrib><title>Long-Term Outcomes in IgA Nephropathy</title><title>Clinical journal of the American Society of Nephrology</title><addtitle>Clin J Am Soc Nephrol</addtitle><description>IgA nephropathy can progress to kidney failure, and risk assessment soon after diagnosis has advantages both for clinical management and the development of new therapeutics. We present relationships among proteinuria, eGFR slope, and lifetime risks for kidney failure.
The IgA nephropathy cohort (2299 adults and 140 children) of the UK National Registry of Rare Kidney Diseases (RaDaR) was analyzed. Patients enrolled had a biopsy-proven diagnosis of IgA nephropathy plus proteinuria >0.5 g/d or eGFR <60 ml/min per 1.73 m 2 . Incident and prevalent populations and a population representative of a typical phase 3 clinical trial cohort were studied. Analyses of kidney survival were conducted using Kaplan-Meier and Cox regression. eGFR slope was estimated using linear mixed models with random intercept and slope.
The median (Q1, Q3) follow-up was 5.9 (3.0, 10.5) years; 50% of patients reached kidney failure or died in the study period. The median (95% confidence interval [CI]) kidney survival was 11.4 (10.5 to 12.5) years; the mean age at kidney failure/death was 48 years, and most patients progressed to kidney failure within 10-15 years. On the basis of eGFR and age at diagnosis, almost all patients were at risk of progression to kidney failure within their expected lifetime unless a rate of eGFR loss ≤1 ml/min per 1.73 m 2 per year was maintained. Time-averaged proteinuria was significantly associated with worse kidney survival and more rapid eGFR loss in incident, prevalent, and clinical trial populations. Thirty percent of patients with time-averaged proteinuria of 0.44 to <0.88 g/g and approximately 20% of patients with time-averaged proteinuria <0.44 g/g developed kidney failure within 10 years. In the clinical trial population, each 10% decrease in time-averaged proteinuria from baseline was associated with a hazard ratio (95% CI) for kidney failure/death of 0.89 (0.87 to 0.92).
Outcomes in this large IgA nephropathy cohort are generally poor with few patients expected to avoid kidney failure in their lifetime. Significantly, patients traditionally regarded as being low risk, with proteinuria <0.88 g/g (<100 mg/mmol), had high rates of kidney failure within 10 years.</description><subject>Adult</subject><subject>Child</subject><subject>Disease Progression</subject><subject>Glomerular Filtration Rate</subject><subject>Glomerulonephritis, IGA - complications</subject><subject>Glomerulonephritis, IGA - epidemiology</subject><subject>Humans</subject><subject>Kidney</subject><subject>Kidney Failure, Chronic - therapy</subject><subject>Proteinuria - etiology</subject><subject>Retrospective Studies</subject><issn>1555-9041</issn><issn>1555-905X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNpdkE1PwkAQhjdGI4j-A2N6MfFS3Nnd6dIjIX5gGrhg4m2zbAeoaWndbQ_8ezEgMc7lncP7kTyM3QIfCgH4OHmbDfnfA4lnrA-IGKccP85Pv4Ieuwrhk3OlpMBL1pOaI0KKfXaf1dt1vCBfRfOudXVFISq20XQ9jmbUbHzd2Hazu2YXK1sGujnqgL0_Py0mr3E2f5lOxlnsJMo2Voh5voSUViOrZQ7AHZETTiXolEBLlqOWXGtLqBJrhU4E2JQQJQIkTg7Yw6G38fVXR6E1VREclaXdUt0FI0Yc0pEAJfZWdbA6X4fgaWUaX1TW7wxw8wPI7AGZ_4D2sbvjQresKD-FfonIb8VzXgQ</recordid><startdate>20230601</startdate><enddate>20230601</enddate><creator>Pitcher, David</creator><creator>Braddon, Fiona</creator><creator>Hendry, Bruce</creator><creator>Mercer, Alex</creator><creator>Osmaston, Kate</creator><creator>Saleem, Moin A</creator><creator>Steenkamp, Retha</creator><creator>Wong, Katie</creator><creator>Turner, A Neil</creator><creator>Wang, Kaijun</creator><creator>Gale, Daniel P</creator><creator>Barratt, Jonathan</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7950-7685</orcidid><orcidid>https://orcid.org/0000-0003-3019-6369</orcidid><orcidid>https://orcid.org/0000-0003-3448-5651</orcidid><orcidid>https://orcid.org/0000-0002-9170-1579</orcidid><orcidid>https://orcid.org/0009-0006-5279-1416</orcidid><orcidid>https://orcid.org/0000-0003-4547-873</orcidid><orcidid>https://orcid.org/0000-0002-9175-9236</orcidid><orcidid>https://orcid.org/0009-0006-5356-758</orcidid><orcidid>https://orcid.org/0009-0001-6625-0737</orcidid><orcidid>https://orcid.org/0000-0002-9808-4518</orcidid><orcidid>https://orcid.org/0009-0006-5356-758X</orcidid><orcidid>https://orcid.org/0000-0003-4547-873X</orcidid></search><sort><creationdate>20230601</creationdate><title>Long-Term Outcomes in IgA Nephropathy</title><author>Pitcher, David ; Braddon, Fiona ; Hendry, Bruce ; Mercer, Alex ; Osmaston, Kate ; Saleem, Moin A ; Steenkamp, Retha ; Wong, Katie ; Turner, A Neil ; Wang, Kaijun ; Gale, Daniel P ; Barratt, Jonathan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c353t-455ddb19ef8a73d110ceec2c465c425aea0573077ae546aa27621a9e5535116c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Child</topic><topic>Disease Progression</topic><topic>Glomerular Filtration Rate</topic><topic>Glomerulonephritis, IGA - complications</topic><topic>Glomerulonephritis, IGA - epidemiology</topic><topic>Humans</topic><topic>Kidney</topic><topic>Kidney Failure, Chronic - therapy</topic><topic>Proteinuria - etiology</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pitcher, David</creatorcontrib><creatorcontrib>Braddon, Fiona</creatorcontrib><creatorcontrib>Hendry, Bruce</creatorcontrib><creatorcontrib>Mercer, Alex</creatorcontrib><creatorcontrib>Osmaston, Kate</creatorcontrib><creatorcontrib>Saleem, Moin A</creatorcontrib><creatorcontrib>Steenkamp, Retha</creatorcontrib><creatorcontrib>Wong, Katie</creatorcontrib><creatorcontrib>Turner, A Neil</creatorcontrib><creatorcontrib>Wang, Kaijun</creatorcontrib><creatorcontrib>Gale, Daniel P</creatorcontrib><creatorcontrib>Barratt, Jonathan</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical journal of the American Society of Nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pitcher, David</au><au>Braddon, Fiona</au><au>Hendry, Bruce</au><au>Mercer, Alex</au><au>Osmaston, Kate</au><au>Saleem, Moin A</au><au>Steenkamp, Retha</au><au>Wong, Katie</au><au>Turner, A Neil</au><au>Wang, Kaijun</au><au>Gale, Daniel P</au><au>Barratt, Jonathan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-Term Outcomes in IgA Nephropathy</atitle><jtitle>Clinical journal of the American Society of Nephrology</jtitle><addtitle>Clin J Am Soc Nephrol</addtitle><date>2023-06-01</date><risdate>2023</risdate><volume>18</volume><issue>6</issue><spage>727</spage><epage>738</epage><pages>727-738</pages><issn>1555-9041</issn><eissn>1555-905X</eissn><abstract>IgA nephropathy can progress to kidney failure, and risk assessment soon after diagnosis has advantages both for clinical management and the development of new therapeutics. We present relationships among proteinuria, eGFR slope, and lifetime risks for kidney failure.
The IgA nephropathy cohort (2299 adults and 140 children) of the UK National Registry of Rare Kidney Diseases (RaDaR) was analyzed. Patients enrolled had a biopsy-proven diagnosis of IgA nephropathy plus proteinuria >0.5 g/d or eGFR <60 ml/min per 1.73 m 2 . Incident and prevalent populations and a population representative of a typical phase 3 clinical trial cohort were studied. Analyses of kidney survival were conducted using Kaplan-Meier and Cox regression. eGFR slope was estimated using linear mixed models with random intercept and slope.
The median (Q1, Q3) follow-up was 5.9 (3.0, 10.5) years; 50% of patients reached kidney failure or died in the study period. The median (95% confidence interval [CI]) kidney survival was 11.4 (10.5 to 12.5) years; the mean age at kidney failure/death was 48 years, and most patients progressed to kidney failure within 10-15 years. On the basis of eGFR and age at diagnosis, almost all patients were at risk of progression to kidney failure within their expected lifetime unless a rate of eGFR loss ≤1 ml/min per 1.73 m 2 per year was maintained. Time-averaged proteinuria was significantly associated with worse kidney survival and more rapid eGFR loss in incident, prevalent, and clinical trial populations. Thirty percent of patients with time-averaged proteinuria of 0.44 to <0.88 g/g and approximately 20% of patients with time-averaged proteinuria <0.44 g/g developed kidney failure within 10 years. In the clinical trial population, each 10% decrease in time-averaged proteinuria from baseline was associated with a hazard ratio (95% CI) for kidney failure/death of 0.89 (0.87 to 0.92).
Outcomes in this large IgA nephropathy cohort are generally poor with few patients expected to avoid kidney failure in their lifetime. Significantly, patients traditionally regarded as being low risk, with proteinuria <0.88 g/g (<100 mg/mmol), had high rates of kidney failure within 10 years.</abstract><cop>United States</cop><pmid>37055195</pmid><doi>10.2215/CJN.0000000000000135</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-7950-7685</orcidid><orcidid>https://orcid.org/0000-0003-3019-6369</orcidid><orcidid>https://orcid.org/0000-0003-3448-5651</orcidid><orcidid>https://orcid.org/0000-0002-9170-1579</orcidid><orcidid>https://orcid.org/0009-0006-5279-1416</orcidid><orcidid>https://orcid.org/0000-0003-4547-873</orcidid><orcidid>https://orcid.org/0000-0002-9175-9236</orcidid><orcidid>https://orcid.org/0009-0006-5356-758</orcidid><orcidid>https://orcid.org/0009-0001-6625-0737</orcidid><orcidid>https://orcid.org/0000-0002-9808-4518</orcidid><orcidid>https://orcid.org/0009-0006-5356-758X</orcidid><orcidid>https://orcid.org/0000-0003-4547-873X</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1555-9041 |
| ispartof | Clinical journal of the American Society of Nephrology, 2023-06, Vol.18 (6), p.727-738 |
| issn | 1555-9041 1555-905X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2801982142 |
| source | PMC (PubMed Central); American Society of Nephrology |
| subjects | Adult Child Disease Progression Glomerular Filtration Rate Glomerulonephritis, IGA - complications Glomerulonephritis, IGA - epidemiology Humans Kidney Kidney Failure, Chronic - therapy Proteinuria - etiology Retrospective Studies |
| title | Long-Term Outcomes in IgA Nephropathy |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-29T00%3A48%3A38IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Long-Term%20Outcomes%20in%20IgA%20Nephropathy&rft.jtitle=Clinical%20journal%20of%20the%20American%20Society%20of%20Nephrology&rft.au=Pitcher,%20David&rft.date=2023-06-01&rft.volume=18&rft.issue=6&rft.spage=727&rft.epage=738&rft.pages=727-738&rft.issn=1555-9041&rft.eissn=1555-905X&rft_id=info:doi/10.2215/CJN.0000000000000135&rft_dat=%3Cproquest_cross%3E2801982142%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c353t-455ddb19ef8a73d110ceec2c465c425aea0573077ae546aa27621a9e5535116c3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2801982142&rft_id=info:pmid/37055195&rfr_iscdi=true |