Severe Adverse Effects Associated With Corticosteroid Treatment in Patients With IgA Nephropathy

Few data are available on the risk of SAEs in corticosteroid users in IgAN populations. We describe the prevalence and risk factors of corticosteroid-related SAEs in a Chinese cohort.

A total of 1034 IgAN patients were followed up in our renal center from 2003 to 2014. Prevalence of corticosteroid use and corticosteroid-related SAEs were noted. Logistic regression was used to search for risk factors of SAEs in corticosteroid users.

Of the 369 patients with steroids therapy, 46 patients (12.5%) with 58 events suffered SAEs, whereas only 18 patients (2.7%) without corticosteroids suffered SAEs (OR: 5.45; 95% CI: 3.07-9.68; P < 0.001). SAEs included diabetes mellitus (n = 19, 5.1%), severe or fatal infection (n = 18, 4.9%), osteonecrosis of the femoral head or bone fracture (n = 6, 1.6%), cardiocerebral vascular disease (n = 4, 1.1%), cataract (n = 3, 0.8%), and gastrointestinal hemorrhage (n = 1, 0.3%). Multivariable logistic regression analysis revealed that advanced age (OR: 1.05; 95% CI: 1.02-1.07; P < 0.001) and hypertension (OR: 1.04; 95% CI: 1.01-1.06; P = 0.009) were risk factors for corticosteroid-related SAEs. Impaired kidney function (estimated GFR: OR: O.98; 95% CI: 0.96-0.99; P = 0.036) was a risk factor for severe infection. Accumulated dosages of corticosteroids were not identified as a risk factor of SAEs (OR: 1.09; 95% CI: 0.91-1.30; P = 0.365).

Corticosteroid use is associated with a high risk of SAEs in IgAN patients, especially those who are older, have hypertension, or impaired renal function. Current guidelines on corticosteroid regimens in IgAN should be reviewed with regard to safety.