Xiangling Li1, Youxia Liu, Jicheng Lv, Sufang Shi, Lijun Liu, Yuqing Chen, Hong Zhang. 1. Renal Division, Peking University First Hospital, Beijing, China;, †Peking University Institute of Nephrology, Beijing, China;, ‡Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China;, §Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China, ‖Department of Nephrology, Affiliated Hospital of Weifang Medical College, Shandong, China.
Abstract
BACKGROUND AND OBJECTIVES: Current therapy for IgA nephropathy mainly includes renin-angiotensin system inhibitors and adding steroids for patients with persistent proteinuria. This study aimed to evaluate kidney disease progression and its risk factors in a Chinese cohort under current therapy. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Patients with IgA nephropathy followed up for at least 12 months from a prospective database were involved. Renal survival and the relationship between clinical parameters and composite kidney failure events (defined as end stage kidney failure or eGFR halving) were assessed. RESULTS: Overall, 703 patients between 2003 and 2011 were enrolled in this study, with a mean follow-up time of 45 months. Mean eGFR was 84.0 ml/min per 1.73 m(2), systolic BP was 124 mmHg, and time-averaged mean arterial pressure was 90.0 mmHg. Median proteinuria at baseline was 1.60 g/d, and time-averaged proteinuria was 0.80 g/d. The mean rate of eGFR decline was -3.12 ml/min per 1.73 m(2) per year (95% confidence interval, -19.07 to 11.80), and annual end stage kidney failure rate was 2.3%. Multivariate Cox regression analyses revealed that baseline eGFR (hazard ratio, 0.76 per 10 ml/min per 1.73 m(2); 95% confidence interval, 0.66 to 0.91), proteinuria at 6 months (hazard ratio, 1.53 per g/d; 95% confidence interval, 1.27 to 1.84), and systolic BP control at 6 months (hazard ratio, 1.36 per 10 mmHg; 95% confidence interval, 1.05 to 1.77) were associated with composite kidney failure events. Baseline eGFR (regression coefficient, -0.06; 95% confidence interval, -0.07 to -0.04), time-averaged proteinuria (regression coefficient, -0.21; 95% confidence interval, -0.25 to -0.16), and time-averaged mean arterial pressure (regression coefficient, -0.15; 95% confidence interval, -0.21 to -0.09) were independent predictors of the slope of eGFR by linear regression. CONCLUSION: Lower proteinuria and lower BP were associated with slower eGFR decline and lower risk of end stage kidney failure in patients currently being treated for IgA nephropathy.
BACKGROUND AND OBJECTIVES: Current therapy for IgA nephropathy mainly includes renin-angiotensin system inhibitors and adding steroids for patients with persistent proteinuria. This study aimed to evaluate kidney disease progression and its risk factors in a Chinese cohort under current therapy. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Patients with IgA nephropathy followed up for at least 12 months from a prospective database were involved. Renal survival and the relationship between clinical parameters and composite kidney failure events (defined as end stage kidney failure or eGFR halving) were assessed. RESULTS: Overall, 703 patients between 2003 and 2011 were enrolled in this study, with a mean follow-up time of 45 months. Mean eGFR was 84.0 ml/min per 1.73 m(2), systolic BP was 124 mmHg, and time-averaged mean arterial pressure was 90.0 mmHg. Median proteinuria at baseline was 1.60 g/d, and time-averaged proteinuria was 0.80 g/d. The mean rate of eGFR decline was -3.12 ml/min per 1.73 m(2) per year (95% confidence interval, -19.07 to 11.80), and annual end stage kidney failure rate was 2.3%. Multivariate Cox regression analyses revealed that baseline eGFR (hazard ratio, 0.76 per 10 ml/min per 1.73 m(2); 95% confidence interval, 0.66 to 0.91), proteinuria at 6 months (hazard ratio, 1.53 per g/d; 95% confidence interval, 1.27 to 1.84), and systolic BP control at 6 months (hazard ratio, 1.36 per 10 mmHg; 95% confidence interval, 1.05 to 1.77) were associated with composite kidney failure events. Baseline eGFR (regression coefficient, -0.06; 95% confidence interval, -0.07 to -0.04), time-averaged proteinuria (regression coefficient, -0.21; 95% confidence interval, -0.25 to -0.16), and time-averaged mean arterial pressure (regression coefficient, -0.15; 95% confidence interval, -0.21 to -0.09) were independent predictors of the slope of eGFR by linear regression. CONCLUSION: Lower proteinuria and lower BP were associated with slower eGFR decline and lower risk of end stage kidney failure in patients currently being treated for IgA nephropathy.
Authors: Jicheng Lv; Damin Xu; Vlado Perkovic; Xinxin Ma; David W Johnson; Mark Woodward; Adeera Levin; Hong Zhang; Haiyan Wang Journal: J Am Soc Nephrol Date: 2012-04-26 Impact factor: 10.121
Authors: Jiri Mestecky; Milan Raska; Bruce A Julian; Ali G Gharavi; Matthew B Renfrow; Zina Moldoveanu; Lea Novak; Karel Matousovic; Jan Novak Journal: Annu Rev Pathol Date: 2012-10-18 Impact factor: 23.472
Authors: Francois Berthoux; Hitoshi Suzuki; Lise Thibaudin; Hiroyuki Yanagawa; Nicolas Maillard; Christophe Mariat; Yasuhiko Tomino; Bruce A Julian; Jan Novak Journal: J Am Soc Nephrol Date: 2012-08-16 Impact factor: 10.121
Authors: Na Zhao; Ping Hou; Jicheng Lv; Zina Moldoveanu; Yifu Li; Krzysztof Kiryluk; Ali G Gharavi; Jan Novak; Hong Zhang Journal: Kidney Int Date: 2012-06-06 Impact factor: 10.612
Authors: Muh Geot Wong; Jicheng Lv; Michelle A Hladunewich; Vivekanand Jha; Lai Seong Hooi; Helen Monaghan; Minghui Zhao; Sean Barbour; Heather N Reich; Daniel Cattran; Richard Glassock; Adeera Levin; Meg J Jardine; David C Wheeler; Mark Woodward; Laurent Billot; Tak Mao Chan; Zhi-Hong Liu; David W Johnson; Alan Cass; John Feehally; Jürgen Floege; Giuseppe Remuzzi; Yangfeng Wu; Rajiv Agarwal; Hong Zhang; Vlado Perkovic Journal: Am J Nephrol Date: 2021-11-03 Impact factor: 3.754
Authors: Jicheng Lv; Hong Zhang; Muh Geot Wong; Meg J Jardine; Michelle Hladunewich; Vivek Jha; Helen Monaghan; Minghui Zhao; Sean Barbour; Heather Reich; Daniel Cattran; Richard Glassock; Adeera Levin; David Wheeler; Mark Woodward; Laurent Billot; Tak Mao Chan; Zhi-Hong Liu; David W Johnson; Alan Cass; John Feehally; Jürgen Floege; Giuseppe Remuzzi; Yangfeng Wu; Rajiv Agarwal; Hai-Yan Wang; Vlado Perkovic Journal: JAMA Date: 2017-08-01 Impact factor: 56.272