Advertisement
Mayo Clinic Proceedings Home

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

Published:January 24, 2018DOI:https://doi.org/10.1016/j.mayocp.2017.10.021

      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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Saran R.
        • Li Y.
        • Robinson B.
        • et al.
        US Renal Data System 2015 Annual Data Report: Epidemiology of Kidney Disease in the United States.
        Am J Kidney Dis. 2016; 67 (S1-S305): Svii
        • Collins A.J.
        • Foley R.N.
        • Chavers B.
        • et al.
        US Renal Data System 2013 Annual Data Report.
        Am J Kidney Dis. 2014; 63: A7
        • Wetmore J.B.
        • Guo H.
        • Liu J.
        • Collins A.J.
        • Gilbertson D.T.
        The incidence, prevalence, and outcomes of glomerulonephritis derived from a large retrospective analysis.
        Kidney Int. 2016; 90: 853-860
        • McGrogan A.
        • Franssen C.F.
        • de Vries C.S.
        The incidence of primary glomerulonephritis worldwide: a systematic review of the literature.
        Nephrol Dial Transplant. 2011; 26: 414-430
        • Sim J.J.
        • Batech M.
        • Hever A.
        • et al.
        Distribution of biopsy-proven presumed primary glomerulonephropathies in 2000-2011 among a racially and ethnically diverse US population.
        Am J Kidney Dis. 2016; 68: 533-544
        • O'Shaughnessy M.M.
        • Montez-Rath M.E.
        • Lafayette R.A.
        • Winkelmayer W.C.
        Patient characteristics and outcomes by GN subtype in ESRD.
        Clin J Am Soc Nephrol. 2015; 10: 1170-1178
        • Laurin L.P.
        • Gasim A.M.
        • Derebail V.K.
        • et al.
        Renal survival in patients with collapsing compared with not otherwise specified FSGS.
        Clin J Am Soc Nephrol. 2016; 11: 1752-1759
        • Lee H.
        • Kim D.K.
        • Oh K.H.
        • et al.
        Mortality and renal outcome of primary glomerulonephritis in Korea: observation in 1,943 biopsied cases.
        Am J Nephrol. 2013; 37: 74-83
        • Young E.W.
        ESRD outcomes and GN subtypes.
        Clin J Am Soc Nephrol. 2015; 10: 1117-1118
        • Chou Y.H.
        • Lien Y.C.
        • Hu F.C.
        • et al.
        Clinical outcomes and predictors for ESRD and mortality in primary GN.
        Clin J Am Soc Nephrol. 2012; 7: 1401-1408
        • Chembo C.L.
        • Marshall M.R.
        • Williams L.C.
        • et al.
        Long-term outcomes for primary glomerulonephritis: New Zealand Glomerulonephritis Study.
        Nephrology (Carlton). 2015; 20: 899-907
        • Moranne O.
        • Watier L.
        • Rossert J.
        • Stengel B.
        • GN-Progress Study Group
        Primary glomerulonephritis: an update on renal survival and determinants of progression.
        QJM. 2008; 101: 215-224
        • Koebnick C.
        • Langer-Gould A.M.
        • Gould M.K.
        • et al.
        Sociodemographic characteristics of members of a large, integrated health care system: comparison with US Census Bureau data.
        Perm J. 2012; 16: 37-41
        • Pham T.T.
        • Sim J.J.
        • Kujubu D.A.
        • Liu I.L.
        • Kumar V.A.
        Prevalence of nondiabetic renal disease in diabetic patients.
        Am J Nephrol. 2007; 27: 322-328
        • Quan H.
        • Parsons G.A.
        • Ghali W.A.
        Validity of information on comorbidity derived from ICD-9-CCM administrative data.
        Med Care. 2002; 40: 675-685
        • Levey A.S.
        • Stevens L.A.
        • Schmid C.H.
        • et al.
        • CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
        A new equation to estimate glomerular filtration rate.
        Ann Intern Med. 2009; 150 ([published correction appears in Ann Intern Med. 2011;155(6):408]): 604-612
        • Foley R.N.
        • Chen S.C.
        • Solid C.A.
        • Gilbertson D.T.
        • Collins A.J.
        Early mortality in patients starting dialysis appears to go unregistered.
        Kidney Int. 2014; 86: 392-398
        • Chan K.E.
        • Maddux F.W.
        • Tolkoff-Rubin N.
        • Karumanchi S.A.
        • Thadhani R.
        • Hakim R.M.
        Early outcomes among those initiating chronic dialysis in the United States.
        Clin J Am Soc Nephrol. 2011; 6: 2642-2649
        • Fine J.P.
        • Gray R.J.
        A proportional hazards model for the subdistribution of a competing risk.
        J Am Stat Assoc. 1999; 94: 496-509
        • Waldman M.
        • Crew R.J.
        • Valeri A.
        • et al.
        Adult minimal-change disease: clinical characteristics, treatment, and outcomes.
        Clin J Am Soc Nephrol. 2007; 2: 445-453
        • Lee S.W.
        • Yu M.Y.
        • Baek S.H.
        • et al.
        Glomerular immune deposits are predictive of poor long-term outcome in patients with adult biopsy-proven minimal change disease: a cohort study in Korea.
        PLoS One. 2016; 11: e0147387
      1. Chapter 8: Transition of Care in Chronic Kidney Disease.
        (United States Renal Data System website) (Accessed April 27, 2017)
        • Woo K.T.
        • Chan C.M.
        • Chin Y.M.
        • et al.
        Global evolutionary trend of the prevalence of primary glomerulonephritis over the past three decades.
        Nephron Clin Pract. 2010; 116: c337-c346
        • Ruggenenti P.
        • Mosconi L.
        • Vendramin G.
        • et al.
        ACE inhibition improves glomerular size selectivity in patients with idiopathic membranous nephropathy and persistent nephrotic syndrome.
        Am J Kidney Dis. 2000; 35: 381-391
        • Woo K.T.
        • Lau Y.K.
        • Wong K.S.
        • Chiang G.S.
        ACEI/ATRA therapy decreases proteinuria by improving glomerular permselectivity in IgA nephritis.
        Kidney Int. 2000; 58: 2485-2491
        • D'Amico G.
        Influence of clinical and histological features on actuarial renal survival in adult patients with idiopathic IgA nephropathy, membranous nephropathy, and membranoproliferative glomerulonephritis: survey of the recent literature.
        Am J Kidney Dis. 1992; 20: 315-323
        • Shimizu A.
        • Takei T.
        • Uchida K.
        • Tsuchiya K.
        • Nitta K.
        Predictors of poor outcomes in steroid therapy for immunoglobulin A nephropathy.
        Nephrology (Carlton). 2009; 14: 521-526
        • Glassock R.J.
        Diagnosis and natural course of membranous nephropathy.
        Semin Nephrol. 2003; 23: 324-332
        • Danforth K.N.
        • Smith A.E.
        • Loo R.K.
        • Jacobsen S.J.
        • Mittman B.S.
        • Kanter M.H.
        Electronic clinical surveillance to improve outpatient care: diverse applications within an integrated delivery system.
        EGEMS (Wash DC). 2014; 2: 1056
        • Kanter M.H.
        • Lindsay G.
        • Bellows J.
        • Chase A.
        Complete care at Kaiser Permanente: transforming chronic and preventive care.
        Jt Comm J Qual Patient Saf. 2013; 39: 484-494
        • Sim J.J.
        • Rutkowski M.P.
        • Selevan D.C.
        • et al.
        Kaiser Permanente Creatinine Safety Program: a mechanism to ensure widespread detection and care for chronic kidney disease.
        Am J Med. 2015; 128: 1204-1211.e1201
        • Kiffel J.
        • Rahimzada Y.
        • Trachtman H.
        Focal segmental glomerulosclerosis and chronic kidney disease in pediatric patients.
        Adv Chronic Kidney Dis. 2011; 18: 332-338
        • Barbour S.J.
        • Cattran D.C.
        • Espino-Hernandez G.
        • Hladunewich M.A.
        • Reich H.N.
        Identifying the ideal metric of proteinuria as a predictor of renal outcome in idiopathic glomerulonephritis.
        Kidney Int. 2015; 88: 1392-1401
        • Cattran D.C.
        • Reich H.N.
        • Beanlands H.J.
        • Miller J.A.
        • Scholey J.W.
        • Troyanov S.
        • Genes, Gender and Glomerulonephritis Group
        The impact of sex in primary glomerulonephritis.
        Nephrol Dial Transplant. 2008; 23: 2247-2253

      Linked Article

      • End-Stage Renal Disease Risk in Different Glomerulonephropathies
        Mayo Clinic ProceedingsVol. 93Issue 7
        • Preview
          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.
        • Full-Text
        • PDF