Abstract
Objective
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.
Results
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).
Conclusion
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)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: January 24, 2018
Footnotes
For editorial comment, see page 133
Grant Support: The work was supported by an investigator-initiated research grant (J.J.S. as a principal investigator) from Mallinckrodt Pharmaceuticals. This work was also supported by the Kaiser Permanente Southern California Clinical Investigator Award (J.J.S.).
Potential Competing Interests: The authors report no competing interests.
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© 2017 Mayo Foundation for Medical Education and Research
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Access this article on ScienceDirectLinked Article
- End-Stage Renal Disease Risk in Different GlomerulonephropathiesMayo Clinic ProceedingsVol. 93Issue 7
- PreviewI 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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