Naslov
Quantifying Duration of Proteinuria Remission and Association with Clinical Outcome in IgA Nephropathy

Autori
Canney, Mark ; Barbour, Sean J. ; Zheng, Yuyan ; Coppo, Rosanna ; Zhang, Hong ; Liu, Zhi-Hong ; Matsuzaki, Keiichi ; Suzuki, Yusuke ; Katafuchi, Ritsuko ; Reich, Heather N. ; Cattran, Daniel ; for the International IgA Nephropathy Network

Kolaboracija
International IgA Nephropathy Network

Izvornik
Journal of the American Society of Nephrology (1046-6673) 32 (2020), 2; 436-447

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, znanstveni

Ključne riječi
IgA nephropathy ; end stage kidney disease ; epidemiology and outcomes ; glomerular disease ; proteinuria ; renal function decline ; renal pathology.

Sažetak
Background: On the basis of findings of observational studies and a meta-analysis, proteinuria reduction has been proposed as a surrogate outcome in IgA nephropathy. How long a reduction in proteinuria needs to be maintained to mitigate the long-term risk of disease progression is unknown. Methods: In this retrospective multiethnic cohort of adult patients with IgA nephropathy, we defined proteinuria remission as a ≥25% reduction in proteinuria from the peak value after biopsy, and an absolute reduction in proteinuria to <1 g/d. The exposure of interest was the total duration of first remission, treated as a time-varying covariate using longitudinal proteinuria measurements. We used time-dependent Cox proportional hazards regression models to quantify the association between the duration of remission and the primary outcome (ESKD or a 50% reduction in eGFR). Results: During a median follow-up of 3.9 years, 274 of 1864 patients (14.7%) experienced the primary outcome. The relationship between duration of proteinuria remission and outcome was nonlinear. Each 3 months in sustained remission up to approximately 4 years was associated with an additional 9% reduction in the risk of disease progression (hazard ratio [HR], 0.91 ; 95% confidence interval [95% CI], 0.89 to 0.93). Thereafter, each additional 3 months in remission was associated with a smaller, nonsignificant risk reduction (HR, 0.99 ; 95% CI, 0.96 to 1.03). These findings were robust to multivariable adjustment and consistent across clinical and histologic subgroups. Conclusions: Our findings support the use of proteinuria as a surrogate outcome in IgA nephropathy, but additionally demonstrate the value of quantifying the duration of proteinuria remission when estimating the risk of hard clinical endpoints.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA