Lei Zhang1,2,3, Xusheng Liu3, Elaine M Pascoe1,4, Sunil V Badve1,2,4, Neil C Boudville1,5, Philip A Clayton1,6,7, Janak De Zoysa8,9, Carmel M Hawley1,2,4, John Kanellis1,10, Stephen P McDonald1,11, Chen Au Peh11, Kevan R Polkinghorne1,10,12, David W Johnson1,2,4. 1. ANZDATA Registry, Adelaide, Australia. 2. Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia. 3. Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China. 4. Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia. 5. School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, The University of Western Australia, Perth, Australia. 6. Department of Nephrology, Prince of Wales Hospital, Sydney, Australia. 7. School of Public Health, University of Sydney, Sydney, Australia. 8. Department of Renal Medicine, North Shore Hospital, Auckland, New Zealand. 9. The University of Auckland, Auckland, New Zealand. 10. Department of Nephrology, Monash Health and Department of Medicine, Melbourne, Australia. 11. School of Medicine, University of Adelaide, Adelaide, Australia. 12. School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Abstract
BACKGROUND: Clinical outcomes of patients with end-stage kidney disease (ESKD) receiving renal replacement therapy (RRT) secondary to IgA nephropathy (IgAN) have not been well described. AIM: To investigate the characteristics, treatments and outcomes of ESKD because of kidney-limited IgAN and Henoch-Schönlein purpura nephritis (HSPN) in the Australian and New Zealand RRT populations. METHODS: All ESKD patients who commenced RRT in Australia and New Zealand between 1971 and 2012 were included. Dialysis and transplant outcomes were evaluated in both a contemporary cohort (1998-2012) and the entire cohort (1971-2012). RESULTS: Of 63 297 ESKD patients, 3721 had kidney-limited IgAN, and 131 had HSPN. For the contemporary cohort of IgAN patients on dialysis (n = 2194), 10-year patient survival was 65%. Of 1368 contemporary IgAN patients who received their first renal allograft, 10-year patient, overall renal allograft and death-censored renal allograft survival were 93%, 82% and 88%, respectively. Using multivariable Cox regression analysis, patients with IgAN had favourable dialysis patient survival (adjusted hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.57-0.69), overall renal allograft survival (HR 0.67, 95% CI 0.57-0.79) and renal transplant patient survival (HR 0.58, 95% CI 0.45-0.74) compared with ESKD controls. Similar results were found in the entire cohort and when using competing-risks models. Compared with kidney-limited IgAN patients, those with HSPN had worse dialysis patient survival (HR 1.94, 95% CI 1.02-3.69), overall renal allograft survival (HR 3.40, 95% CI 1.00-11.55) and renal transplant patient survival (HR 3.50, 95% CI 1.03-11.92). CONCLUSION: IgAN ESKD was associated with better dialysis and renal transplant outcomes compared with other forms of ESKD. The survival outcomes of ESKD patients with HSPN were worse than kidney-limited IgAN.
BACKGROUND: Clinical outcomes of patients with end-stage kidney disease (ESKD) receiving renal replacement therapy (RRT) secondary to IgA nephropathy (IgAN) have not been well described. AIM: To investigate the characteristics, treatments and outcomes of ESKD because of kidney-limited IgAN and Henoch-Schönlein purpura nephritis (HSPN) in the Australian and New Zealand RRT populations. METHODS: All ESKD patients who commenced RRT in Australia and New Zealand between 1971 and 2012 were included. Dialysis and transplant outcomes were evaluated in both a contemporary cohort (1998-2012) and the entire cohort (1971-2012). RESULTS: Of 63 297 ESKD patients, 3721 had kidney-limited IgAN, and 131 had HSPN. For the contemporary cohort of IgANpatients on dialysis (n = 2194), 10-year patient survival was 65%. Of 1368 contemporary IgANpatients who received their first renal allograft, 10-year patient, overall renal allograft and death-censored renal allograft survival were 93%, 82% and 88%, respectively. Using multivariable Cox regression analysis, patients with IgAN had favourable dialysis patient survival (adjusted hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.57-0.69), overall renal allograft survival (HR 0.67, 95% CI 0.57-0.79) and renal transplant patient survival (HR 0.58, 95% CI 0.45-0.74) compared with ESKD controls. Similar results were found in the entire cohort and when using competing-risks models. Compared with kidney-limited IgANpatients, those with HSPN had worse dialysis patient survival (HR 1.94, 95% CI 1.02-3.69), overall renal allograft survival (HR 3.40, 95% CI 1.00-11.55) and renal transplant patient survival (HR 3.50, 95% CI 1.03-11.92). CONCLUSION:IgAN ESKD was associated with better dialysis and renal transplant outcomes compared with other forms of ESKD. The survival outcomes of ESKD patients with HSPN were worse than kidney-limited IgAN.
Authors: Elisa Delbarba; Maddalena Marasa; Pietro A Canetta; Stacy E Piva; Debanjana Chatterjee; Byum Hee Kil; Xueru Mu; Keisha L Gibson; Michelle A Hladunewich; Jonathan J Hogan; Bruce A Julian; Jason M Kidd; Louis-Philippe Laurin; Patrick H Nachman; Michelle N Rheault; Dana V Rizk; Neil S Sanghani; Howard Trachtman; Scott E Wenderfer; Ali G Gharavi; Andrew S Bomback Journal: Kidney Int Rep Date: 2020-03-20