IgAN and Risks of Kidney and Cardiovascular Events and Death

Area of Science:

• Nephrology
• Epidemiology
• Public Health

Background:

• IgA nephropathy (IgAN) is a common primary glomerulonephritis, yet population-based data on its long-term outcomes in the U.S. are limited.
• Understanding the comparative risks of kidney, cardiovascular, and mortality outcomes for IgAN patients is crucial for clinical management and public health strategies.

Purpose of the Study:

• To compare the risks of adverse kidney, cardiovascular, and mortality outcomes in adults with biopsy-proven IgA nephropathy (IgAN) against those with nonglomerular chronic kidney disease (CKD) and individuals without CKD.

Main Methods:

• Utilized natural language processing (NLP) on electronic health record (EHR) data to identify adults with biopsy-proven IgAN (2010-2020).
• Established two matched comparison cohorts: adults with nonglomerular CKD and adults without CKD.
• Employed multivariable Cox proportional hazards models to compare rates of end-stage kidney disease (ESKD), worsening CKD, acute kidney injury (AKI), cardiovascular outcomes, and mortality through 2021.

Main Results:

• Compared to nonglomerular CKD, IgAN patients had significantly higher adjusted risks of ESKD (aHR: 2.79), worsening CKD (aHR: 3.05), and AKI (aHR: 1.45).
• Compared to individuals without CKD, IgAN patients exhibited substantially higher adjusted risks of adverse kidney outcomes, hospitalization for heart failure (aHR: 8.06), and death (aHR: 2.90).
• No significant adjusted differences in cardiovascular events (excluding heart failure) and death were observed between IgAN and nonglomerular CKD groups.

Conclusions:

• Adults with IgA nephropathy (IgAN) face significantly greater risks for adverse kidney outcomes when compared to those with nonglomerular chronic kidney disease (CKD).
• IgAN is associated with substantially higher risks of heart failure hospitalization and mortality compared to individuals without CKD, highlighting its systemic impact.