Ερευνητικό υλικό ΕΚΠΑ

Quantifying duration of proteinuria remission and association with clinical outcome in IgA nephropathy

Αγγλικά

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. Copyright © 2021 by the American Society of Nephrology.

2021

Canney, M.
Barbour, S.J.
Zheng, Y.
Coppo, R.
Zhang, H.
Liu, Z.-H.
Matsuzaki, K.
Suzuki, Y.
Katafuchi, R.
Reich, H.N.
Cattran, D.
Russo, M.L.
Troyanov, S.
Cook, H.T.
Roberts, I.
Tesar, V.
Maixnerova, D.
Lundberg, S.
Gesualdo, L.
Emma, F.
Fuiano, L.
Beltrame, G.
Rollino, C.
Amore, A.
Camilla, R.
Peruzzi, L.
Praga, M.
Feriozzi, S.
Polci, R.
Segoloni, G.
Colla, L.
Pani, A.
Piras, D.
Angioi, A.
Cancarini, G.
Ravera, S.
Durlik, M.
Moggia, E.
Ballarin, J.
Di Giulio, S.
Pugliese, F.
Serriello, I.
Caliskan, Y.
Sever, M.
Kilicaslan, I.
Locatelli, F.
Del Vecchio, L.
Wetzels, J.F.M.
Peters, H.
Berg, U.
Carvalho, F.
da Costa Ferreira, A.C.
Maggio, M.
Wiecek, A.
Ots-Rosenberg, M.
Magistroni, R.
Topaloglu, R.
Bilginer, Y.
D'Amico, M.
Stangou, M.
Giacchino, F.
Goumenos, D.
Kalliakmani, P.
Gerolymos, M.
Galesic, K.
Geddes, C.
Siamopoulos, K.
Balafa, O.
Galliani, M.
Stratta, P.
Quaglia, M.
Bergia, R.
Cravero, R.
Salvadori, M.
Cirami, L.
Fellstrom, B.
Kloster Smerud, H.
Ferrario, F.
Stellato, T.
Egido, J.
Martin, C.
Floege, J.
Eitner, F.
Lupo, A.
Bernich, P.
Menè, P.
Morosetti, M.
van Kooten, C.
Rabelink, T.
Reinders, M.E.J.
Boria Grinyo, J.M.
Cusinato, S.
Benozzi, L.
Savoldi, S.
Licata, C.
Mizerska-Wasiak, M.
Martina, G.
Messuerotti, A.
Dal Canton, A.
Esposito, C.
Migotto, C.
Triolo, G.
Mariano, F.
Pozzi, C.
Boero, R.
Bellur, S.
Mazzucco, G.
Giannakakis, C.
Honsova, E.
Sundelin, B.
Di Palma, A.M.
Gutiérrez, E.
Asunis, A.M.
Barratt, J.
Tardanico, R.
Perkowska-Ptasinska, A.
Arce Terroba, J.
Fortunato, M.
Pantzaki, A.
Ozluk, Y.
Steenbergen, E.
Soderberg, M.
Riispere, Z.
Furci, L.
Orhan, D.
Kipgen, D.
Casartelli, D.
Galesic Ljubanovic, D.
Gakiopoulou, H.
Bertoni, E.
Cannata Ortiz, P.
Karkoszka, H.
Groene, H.J.
Stoppacciaro, A.
Bajema, I.
Bruijn, J.
Fulladosa Oliveras, X.
Maldyk, J.
Ioachim, E.
Bavbek, N.
Cook, T.
Alpers, C.
Feehally, J.
Berthoux, F.
Bonsib, S.
D'Agati, V.
D'Amico, G.
Emancipator, S.
Emmal, F.
Fervenza, F.
Florquin, S.
Fogo, A.
Groene, H.
Haas, M.
Hill, P.
Hogg, R.
Hsu, S.
Hunley, T.
Hladunewich
Jennette, C.
Joh, K.
Julian, B.
Kawamura, T.
Lai, F.
Leung, C.
Li, L.
Li, P.
Liu, Z.
Massat, A.
Mackinnon, B.
Mezzano, S.
Schena, F.
Tomino, Y.
Walker, P.
Wang, H.
Weening, J.
Yoshikawa, N.
Zeng, C.-H.
Shi, S.
Nogi, C.
Suzuki, H.
Koike, K.
Hirano, K.
Yokoo, T.
Hanai, M.
Fukami, K.
Takahashi, K.
Yuzawa, Y.
Niwa, M.
Yasuda, Y.
Maruyama, S.
Ichikawa, D.
Suzuki, T.
Shirai, S.
Fukuda, A.
Fujimoto, S.
Trimarchi, H.
International IgA Nephropathy Network

Journal of the American Society of Nephrology

American Society of Nephrology

32

2

adult; Article; clinical outcome; cohort analysis; controlled study; data analysis software; disease association; disease exacerbation; estimated glomerular filtration rate; female; follow up; histopathology; human; human tissue; immunoglobulin A nephropathy; kidney biopsy; kidney function; major clinical study; male; meta analysis; observational study; priority journal; proteinuria; quantitative analysis; remission; retrospective study; risk assessment; risk reduction; chronic kidney failure; complication; glomerulus filtration rate; immunoglobulin A nephropathy; middle aged; proportional hazards model; proteinuria; time factor, Adult; Disease Progression; Female; Glomerular Filtration Rate; Glomerulonephritis, IGA; Humans; Kidney Failure, Chronic; Male; Middle Aged; Outcome Assessment, Health Care; Proportional Hazards Models; Proteinuria; Remission Induction; Retrospective Studies; Time Factors

https://doi.org/10.1681/ASN.2020030349

10.1681/ASN.2020030349

https://pergamos.lib.uoa.gr/uoa/dl/object/3102830