Shigeru Tanaka1, Toshiharu Ninomiya1,2, Ritsuko Katafuchi3, Kosuke Masutani1, Masaharu Nagata1, Akihiro Tsuchimoto1, Hideki Hirakata4, Takanari Kitazono1,2, Kazuhiko Tsuruya5,6. 1. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 2. Division of Research Management, Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 3. Kidney Unit, National Fukuoka-Higashi Medical Center, Koga, Japan. 4. Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan. 5. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. tsuruya@intmed2.med.kyushu-u.ac.jp. 6. Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. tsuruya@intmed2.med.kyushu-u.ac.jp.
Abstract
BACKGROUND: The impact of renin-angiotensin system blockade (RASB) on the incidence of end-stage renal disease (ESRD) remains unclear in IgA nephropathy (IgAN). METHODS: This study assessed associations between RASB treatment and the incidence of ESRD in IgAN using propensity score approaches. We retrospectively analyzed 1273 patients with IgAN biopsied between 1979 and 2010. Propensity scores were calculated using logistic regression. Associations between RASB and ESRD were examined using a Cox regression model adjusted by inverse probability of treatment weighted, regression, stratification and matching. RESULTS: During follow-up (median 5.1 years), 130 patients developed ESRD. With Cox regression adjusted by inverse probability of treatment weighted, RASB use was significantly associated with a lower risk of ESRD (hazard ratio 0.58; 95 % confidence interval 0.42-0.80). Significant associations were observed for other propensity score-based approaches. In stratified analysis, a beneficial association between RASB and ESRD was observed in patients ≥35 years, with hypertension, reduced estimated glomerular filtration rate (<60 mL/min/1.73 m2), mesangial proliferation and segmental glomerulosclerosis (P for interaction <0.05), and tended to be greater in patients with proteinuria (≥1.0 g/24 h), extracapillary proliferation and receiving methylprednisolone pulse therapy (P for interaction <0.10). CONCLUSION: Treatment with RASB was associated with a lower incidence of ESRD in the real-world practice of IgAN.
BACKGROUND: The impact of renin-angiotensin system blockade (RASB) on the incidence of end-stage renal disease (ESRD) remains unclear in IgA nephropathy (IgAN). METHODS: This study assessed associations between RASB treatment and the incidence of ESRD in IgAN using propensity score approaches. We retrospectively analyzed 1273 patients with IgAN biopsied between 1979 and 2010. Propensity scores were calculated using logistic regression. Associations between RASB and ESRD were examined using a Cox regression model adjusted by inverse probability of treatment weighted, regression, stratification and matching. RESULTS: During follow-up (median 5.1 years), 130 patients developed ESRD. With Cox regression adjusted by inverse probability of treatment weighted, RASB use was significantly associated with a lower risk of ESRD (hazard ratio 0.58; 95 % confidence interval 0.42-0.80). Significant associations were observed for other propensity score-based approaches. In stratified analysis, a beneficial association between RASB and ESRD was observed in patients ≥35 years, with hypertension, reduced estimated glomerular filtration rate (<60 mL/min/1.73 m2), mesangial proliferation and segmental glomerulosclerosis (P for interaction <0.05), and tended to be greater in patients with proteinuria (≥1.0 g/24 h), extracapillary proliferation and receiving methylprednisolone pulse therapy (P for interaction <0.10). CONCLUSION: Treatment with RASB was associated with a lower incidence of ESRD in the real-world practice of IgAN.
Authors: Sharon Reid; Peggy M Cawthon; Jonathan C Craig; Joshua A Samuels; Donald A Molony; Giovanni Fm Strippoli Journal: Cochrane Database Syst Rev Date: 2011-03-16
Authors: Alexandra Cambier; Olivia Boyer; Georges Deschenes; James Gleeson; Anne Couderc; Julien Hogan; Thomas Robert Journal: Pediatr Nephrol Date: 2019-02-18 Impact factor: 3.714
Authors: David T Selewski; Josephine M Ambruzs; Gerald B Appel; Andrew S Bomback; Raed Bou Matar; Yi Cai; Daniel C Cattran; Aftab S Chishti; Vivette D D'Agati; Cynthia J D'Alessandri-Silva; Rasheed A Gbadegesin; Jonathan J Hogan; Sandra Iragorri; J Charles Jennette; Bruce A Julian; Myda Khalid; Richard A Lafayette; Helen Liapis; Francesca Lugani; Sarah A Mansfield; Sherene Mason; Patrick H Nachman; Cynthia C Nast; Carla M Nester; Damien G Noone; Jan Novak; Michelle M O'Shaughnessy; Heather N Reich; Michelle N Rheault; Dana V Rizk; Manish K Saha; Neil S Sanghani; C John Sperati; Rajasree Sreedharan; Tarak Srivastava; Agnieszka Swiatecka-Urban; Katherine Twombley; Tetyana L Vasylyeva; Donald J Weaver; Hong Yin; Jarcy Zee; Ronald J Falk; Ali G Gharavi; Brenda W Gillespie; Debbie S Gipson; Larry A Greenbaum; Lawrence B Holzman; Matthias Kretzler; Bruce M Robinson; William E Smoyer; Michael Flessner; Lisa M Guay-Woodford; Krzysztof Kiryluk Journal: Kidney Int Rep Date: 2018-08-03