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Primary glomerular diseases and long-term adverse health outcomes: A nationwide cohort study
Anne-Laure Faucon1,2, Stefania Lando1,3, Charikleia Chrysostomou4,5
1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Insights
Patients with IgA nephropathy (IgAN) and focal segmental glomerulosclerosis (FSGS) face higher chronic kidney disease (CKD) progression risks. Despite lower hospitalization and mortality rates, targeted treatments are crucial for these glomerular diseases.
Area of Science:
- Nephrology
- Glomerular Diseases
- Chronic Kidney Disease
Background:
- Glomerular diseases are a significant cause of end-stage kidney disease globally.
- Long-term outcomes of glomerular diseases remain poorly understood.
Purpose of the Study:
- To compare the long-term risks of hospitalization, kidney replacement therapy (KRT), major adverse cardiovascular events (MACE), and death among patients with four primary glomerular diseases and controls with common non-communicable CKD etiologies.
- To assess the progression rates of chronic kidney disease (CKD) in patients with IgA nephropathy (IgAN), focal segmental glomerulosclerosis (FSGS), minimal change disease (MCD), and membranous nephropathy (MN) compared to control CKD.
Main Methods:
- Retrospective cohort study using the Swedish Renal Registry.
- Inclusion of patients with CKD stages 3-5.
- Comparison of outcomes between patients with IgAN, FSGS, MCD, MN, and a control group with CKD due to common non-communicable diseases.
Main Results:
- Patients with glomerular diseases generally had lower risks of hospitalization, MACE, and death compared to controls.
- IgA nephropathy (IgAN) and focal segmental glomerulosclerosis (FSGS) were associated with faster estimated glomerular filtration rate (eGFR) decline and higher rates of kidney replacement therapy (KRT).
- Membranous nephropathy (MN) and minimal change disease (MCD) showed slower eGFR decline and lower KRT rates.
Conclusions:
- While IgAN and FSGS patients experience lower relative risks of hospitalization, cardiovascular events, and mortality, they face a higher risk of CKD progression.
- There is a critical need for intensified treatment strategies for IgAN and FSGS to mitigate CKD progression.
- Glomerular diseases necessitate tailored management approaches beyond general CKD care.
Background:
Although glomerular diseases are the third most frequent cause of end-stage kidney disease worldwide, little is known about their long-term outcomes.
Methods:
In patients with chronic kidney disease (CKD) stage 3-5 enrolled in the Swedish Renal Registry, we compared risks of hospitalization, kidney replacement therapy (KRT), major cardiovascular events (MACE), and death of the four most frequent primary glomerular diseases (IgA nephropathy [IgAN], focal segmental glomerulosclerosis [FSGS], minimal change disease [MCD], and membranous nephropathy [MN]), and patients with CKD due to the most common non-communicable diseases (control-CKD).
Results:
We identified 2396 patients with glomerular disease (97% biopsy-proven, 69% men, 57 years, eGFR 29 mL/min/1.73 m2, uACR 88 mg/mmol, 1524 with IgAN, 398 FSGS, 94 MCD, and 380 MN) and 37,697 controls (64% men, 74 years, eGFR 25 mL/min/1.73 m2, uACR 23 mg/mmol), mainly with diabetic nephropathy and nephroangiosclerosis. The median follow-up was 6.3 (3.3; 9.9) years. Compared with control-CKD, patients with primary glomerular diseases generally had a lower risk of hospitalization, MACE (adjusted hazard ratios [HRs] ranging from 0.44 to 0.88 depending on the etiology) and death (HRs ranging 0.45-0.76). Patients with IgAN and FSGS had a faster eGFR decline and a higher rate of KRT (HRs 1.26 [95%CI: 1.15-1.37] and 1.34 [1.15-1.57], respectively). Conversely, patients with MN and MCD had a lower KRT rate and slower eGFR decline.
Conclusion:
Despite having a lower relative risk of hospitalization, cardiovascular events and mortality, patients with IgAN and FSGS are at higher risk of CKD progression than the most common etiologies of CKD, emphasizing the need for more stringent treatment strategies in these patients.
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