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Biopsy-proven CKD etiology and outcomes: the Chronic Kidney Disease Japan Cohort (CKD-JAC) study

Takayuki Hamano1,2, Takahiro Imaizumi3,4, Takeshi Hasegawa5,6,7

  • 1Department of Nephrology, Nagoya City University Graduate School of Medicine, Nagoya, Japan.

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|March 24, 2022
PubMed

Insights

Adding biopsy-proven diagnoses to the GFR-albuminuria (GA) classification significantly improves chronic kidney disease outcome prediction. The cause-GFR-albuminuria (CGA) classification offers greater value than GA alone for predicting kidney failure and death.

Area of Science:

  • Nephrology
  • Clinical Epidemiology
  • Biomarkers

Background:

  • The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend the cause-GFR-albuminuria (CGA) classification for predicting patient outcomes.
  • However, data supporting the inclusion of the specific cause of chronic kidney disease (CKD) in outcome prediction models are limited.
  • This study addresses the need to incorporate prior biopsy-proven diagnoses into CKD outcome prediction.

Purpose of the Study:

  • To evaluate the impact of biopsy-proven kidney disease diagnoses on predicting kidney failure with replacement therapy (KFRT) and all-cause mortality.
  • To compare the predictive performance of the GFR-albuminuria (GA) classification with the enhanced CGA classification that includes biopsy results.

Main Methods:

  • Two analyses were conducted: Analysis A (n=778) examined various biopsy-proven diagnoses, while Analysis B (n=1117) focused on patients with diabetes mellitus, comparing biopsy-proven diabetic nephropathy (DN) with other biopsy findings and no biopsy.
  • Kidney failure with replacement therapy (KFRT) and all-cause death were assessed as outcomes.
  • Fine-Gray (FG) models were used to account for competing risks, with KFRT as the competing event for death, and vice versa.

Main Results:

  • In Analysis A, incorporating biopsy-proven diagnoses into the GA classification significantly improved the prediction of 8-year KFRT and all-cause death.
  • Specific diagnoses showed varying risks: crescentic glomerulonephritis had the highest risk of death (SHR 5.90), while membranous nephropathy (MN) had a lower risk of KFRT (SHR 0.45) compared to IgA nephropathy (IgAN).
  • In Analysis B, non-diabetic biopsy-proven diseases were associated with a lower risk of KFRT compared to biopsy-proven DN (SHR 0.62) when death was a competing event.

Conclusions:

  • The CGA classification, which includes biopsy-proven diagnoses, demonstrates superior value in predicting CKD outcomes compared to the GA classification alone.
  • Biopsy results provide crucial prognostic information, refining risk stratification for patients with CKD.
  • Specific kidney disease etiologies identified via biopsy significantly influence the risk of KFRT and mortality.
Abstract

Keywords:
CKDdiabetic kidney diseaseepidemiologykidney biopsyprognosis

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