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End-Stage Renal Disease and Mortality Outcomes Across Different Glomerulonephropathies in a Large Diverse US Population

Published:January 24, 2018DOI:



      To compare renal function decline, incident end-stage renal disease (ESRD), and mortality among patients with 5 common glomerular diseases in a large diverse population.

      Patients and Methods

      A retrospective cohort study (between January 1, 2000, and December 31, 2011) of patients with glomerulonephropathy using the electronic health record of an integrated health system was performed. Estimated glomerular filtration rate (eGFR) change, incident ESRD, and mortality were compared among patients with biopsy-proven focal segmental glomerulosclerosis (FSGS), membranous glomerulonephritis (MN), minimal change disease (MCD), immunoglobulin A nephropathy (IgAN), and lupus nephritis (LN). Competing risk models were used to estimate hazard ratios for different glomerulonephropathies for incident ESRD, with mortality as a competing outcome after adjusting for potential confounders.


      Of the 2350 patients with glomerulonephropathy (208 patients [9%] younger than 18 years) with a mean follow-up of 4.5±3.6 years, 497 (21%) progressed to ESRD and 195 (8%) died before ESRD. The median eGFR decline was 1.0 mL/min per 1.73 m2 per year but varied across different glomerulonephropathies (P<.001). The highest ESRD incidence (per 100 person-years) was observed in FSGS 8.72 (95% CI, 3.93-16.72) followed by IgAN (4.54; 95% CI, 1.37-11.02), LN (2.38; 95% CI, 0.37-7.82), MN (2.15; 95% CI, 0.29-7.46), and MCD (1.67; 95% CI, 0.15-6.69). Compared with MCD, hazard ratios (95% CIs) for incident ESRD were 3.43 (2.32-5.08) and 2.35 (1.46-3.81), 1.28 (0.79-2.07), and 1.02 (0.62-1.68) for FSGS, IgAN, LN, and MN, respectively. No significant association between glomerulonephropathy types and mortality was detected (P=.24).


      Our findings from a real-world clinical environment revealed significant differences in eGFR decline and ESRD risk among patients with 5 glomerulonephropathies. These variations in presentation and outcomes warrant different management strategies and expectations.

      Abbreviations and Acronyms:

      ACEI (angiotensin-converting enzyme inhibitor), ARB (angiotensin receptor blocker), DM (diabetes mellitus), eGFR (estimated glomerular filtration rate), EHR (electronic health record), ESRD (end-stage renal disease), FSGS (focal segmental glomerulosclerosis), GN (glomerulonephropathy), HR (hazard ratio), HTN (hypertension), IgAN (immunoglobulin A nephropathy), KPSC (Kaiser Permanente Southern California), LN (lupus nephritis), MCD (minimal change disease), MN (membranous glomerulonephritis)
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      Linked Article

      • End-Stage Renal Disease Risk in Different Glomerulonephropathies
        Mayo Clinic ProceedingsVol. 93Issue 7
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          I read with great enthusiasm the excellent report by Sim et al1 of chronic kidney disease (CKD) progression to end-stage renal disease (ESRD) in patients with glomerulonephropathies in the February 2018 issue of Mayo Clinic Proceedings and the accompanying editorial.2 This was a retrospective cohort study of patient renal and mortality outcomes using the electronic health records of Kaiser Permanente Southern California, in patients with biopsy-proven glomerulonephropathies enrolled between January 1, 2000, and December 31, 2011.
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