Quantifying the benefits of remission duration in focal and segmental glomerulosclerosis

医学 局灶节段性肾小球硬化 肾功能 蛋白尿 肾病综合征 内科学 肾脏疾病 回顾性队列研究 置信区间 队列 儿科
作者
Arenn Jauhal,Heather N. Reich,Michelle Hladunewich,Moumita Barua,Bettina E. Hansen,David Naimark,Stéphan Troyanov,Daniel C. Cattran,Neil Ryan,Ling Peng,P. M. Lam,Manuela Romano,S E Albert,Ramona Aslahi,Parvir S. Aujla,Nancy Barrese,Moumita Barua,Murray Berall,A Berbece,S Bhandhal,D R Birbrager,Philip Boll,George P. Buldo,Carl J. Cardella,Charles K. Chan,Paul K. S. Chan,Amélie Charest,David Cherney,Mala Chidambaram,Sin‐Ming Chow,Edward Cole,Matthew J. Cummings,Susie Donnelly,Amy L. Dunn,A. El-Firjani,Sherman Fong,Jasmine L.F. Fung,Jonathan Goldstein,Ziv Harel,Gavril Hercz,Sarbjit V. Jassal,Sahar Kajbaf,K S Kamel,Ah-Young Kang,Stavros Karanicolas,Vincent Ki,S.J. Kim,David H. Kim,Ana Konvalinka,Kiran Kaur Kundhal,Valérie S. Langlois,Poli Lekas,Ilan Lenga,Christoph Licht,Jennifer Lipscombe,Charmaine E. Lok,Jasen Ly,Motharasan Manogaran,Rory McQuillan,Philip A. McFarlane,Hemalkumar B. Mehta,David C. Mendelssohn,Jonathan Miller,Gordon Nagai,Bharat Nathoo,Gihad Nesrallah,Michael Pandes,S.B. Pandeya,Rulan S. Parekh,Rachel J. Pearl,York Pei,David N. Perkins,Jeffrey Perl,Andreas Pierratos,R Prasad,Seetha Radhakrishnan,Maya K. Rao,Rachel Richardson,Janet Roscoe,Amani Roushdi,Jyoti Sachdeva,Daniel G. Sapir,Joanna Sasal,Jeffrey Schiff,James W. Scholey,Martin J. Schreiber,Shan Xu,Nazema Y. Siddiqui,Tabo Sikaneta,Cristina Gómez,Sandeep Singh,Ravish Singhal,Alex Hardip Sohal,Andrew J. Steele,Sunita Suneja,Esther Szaky,Derrick Y. Tam,Paul Tam,L Teskey,Kathryn Tinckam,R. Ting,Stephen Kwok‐Wing Tsui,Paul Turner,Davinder Wadehra,Jose Arturo Wadgymar,Rachel M. Wald,Aziz Walele,Lizette Warner,Wei Cheng,Jordan Weinstein,Catharine Whiteside,S Wijeyasekaran,Grace Lai‐Hung Wong,George Wu,Teraiza Yassa,Darren A. Yuen,Jeffrey S. Zaltzman
出处
期刊:Nephrology Dialysis Transplantation [Oxford University Press]
卷期号:38 (4): 950-960 被引量:2
标识
DOI:10.1093/ndt/gfac238
摘要

Abstract Background Although the clinical benefit of obtaining a remission in proteinuria in nephrotic patients with focal segmental glomerulosclerosis (FSGS) is recognized, the long-term value of maintaining it and the impact of relapses on outcome are not well described. Methods We examined the impact of remissions and relapses on either a 50% decline in kidney function or end-stage kidney disease (combined event) using time-dependent and landmark analyses in a retrospective study of all patients from the Toronto Glomerulonephritis Registry with biopsy-proven FSGS, established nephrotic-range proteinuria and at least one remission. Results In the 203 FSGS individuals with a remission, 89 never relapsed and 114 experienced at least one relapse. The first recurrence was often followed by a repeating pattern of remission and relapse. The 10-year survival from a combined event was 15% higher in those with no relapse versus those with any relapse. This smaller than anticipated difference was related to the favourable outcome in individuals whose relapses quickly remitted. Relapsers who ultimately ended in remission (n = 46) versus in relapse (n = 68) experienced a 91% and 32% 7-year event survival (P < .001), respectively. Using time-varying survival analyses that considered all periods of remission and relapse in every patient and adjusting for each period's initial estimated glomerular filtration rate, the state of relapse was associated with a 2.17 (95% confidence interval 1.32–3.58; P = .002) greater risk of experiencing a combined event even in this FSGS remission cohort. Conclusion In FSGS, unless remissions are maintained and relapses avoided, long-term renal survival remains poor. Treatment strategies addressing remission duration remain poorly defined and should be an essential question in future trials.

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