Patient characteristics and outcomes by GN subtype in ESRD

Outcomes-based research rarely focuses on patients with ESRD caused by GN. The hypotheses were that the GN subtype would clinically discriminate patient groups and independently associate with survival after ESRD therapy initiation. Data were extracted from the US Renal Data System for adult patient...

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Bibliographic Details
Published in:Clinical journal of the American Society of Nephrology 2015-07, Vol.10 (7), p.1170-1178
Main Authors: O'Shaughnessy, Michelle M, Montez-Rath, Maria E, Lafayette, Richard A, Winkelmayer, Wolfgang C
Format: Article
Language:English
Subjects:
Adult
Aged
Comorbidity
Databases, Factual
Female
Glomerulonephritis - complications
Glomerulonephritis - diagnosis
Glomerulonephritis - mortality
Glomerulonephritis - therapy
Humans
Incidence
Kaplan-Meier Estimate
Kidney Failure, Chronic - diagnosis
Kidney Failure, Chronic - etiology
Kidney Failure, Chronic - mortality
Kidney Failure, Chronic - therapy
Kidney Transplantation - adverse effects
Kidney Transplantation - mortality
Male
Middle Aged
Original
Peritoneal Dialysis - adverse effects
Peritoneal Dialysis - mortality
Proportional Hazards Models
Renal Dialysis - adverse effects
Renal Dialysis - mortality
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States - epidemiology
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Summary:Outcomes-based research rarely focuses on patients with ESRD caused by GN. The hypotheses were that the GN subtype would clinically discriminate patient groups and independently associate with survival after ESRD therapy initiation. Data were extracted from the US Renal Data System for adult patients with incident (1996-2011) ESRD attributed to six GN subtypes: FSGS, IgA nephropathy (IgAN), membranous nephropathy, membranoproliferative glomeruonephritis, lupus nephritis (LN), and vasculitis. ESRD attributed to diabetes and autosomal dominant polycystic kidney disease served as non-GN comparators. Unadjusted and adjusted mortality hazard ratios (aHRs) with 95% confidence intervals (95% CIs) were estimated using Cox regression (reference, IgAN). Models sequentially adjusted for sociodemographic (model 2), comorbidity/laboratory (model 3), and ESRD treatment modality (model 4) variables. Among 84,301 patients with ESRD attributed to GN, the median age ranged from 39 (LN) to 66 (vasculitis) years, male sex ranged from 18% (LN) to 68% (IgAN), and black race ranged from 7% (IgAN) to 49% (LN). Patients with IgAN had the fewest comorbidities and lowest use of hemodialysis (70.1%). After a median follow-up of 2.5 (interquartile range, 1.0-4.9) years, crude mortality was lowest in IgAN (3.7 deaths/100 person years). Compared to IgAN, adjusted mortality was highest in LN (model 4 aHR=1.75; 95% CI, 1.68 to 1.83) and in diabetes (aHR=1.73; 95% CI, 1.67 to 1.79), and was also higher in all other GN subtypes (membranous nephropathy: aHR=1.23; 95% CI, 1.17 to 1.29; FSGS: aHR=1.37; 95% CI, 1.32 to 1.42; membranoproliferative GN: aHR=1.38; 95% CI, 1.31 to 1.45; vasculitis: aHR=1.51; 95% CI, 1.45 to 1.58) and in autosomal dominant polycystic kidney disease (aHR=1.22; 95% CI, 1.18 to 1.27). This study exposes substantial heterogeneity across GN subtypes at ESRD therapy initiation and identifies independent associations between GN subtype and post-ESRD mortality. These survival discrepancies warrant further study, and the utility of current research practice to group GN subtypes together when evaluating ESRD outcomes should be questioned.
ISSN:1555-9041
1555-905X
DOI:10.2215/CJN.11261114