End-Stage Renal Disease and Mortality Outcomes Across Different Glomerulonephropathies in a Large Diverse US Population
To compare renal function decline, incident end-stage renal disease (ESRD), and mortality among patients with 5 common glomerular diseases in a large diverse population. A retrospective cohort study (between January 1, 2000, and December 31, 2011) of patients with glomerulonephropathy using the elec...
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| Veröffentlicht in: | Mayo Clinic proceedings 2018-02, Vol.93 (2), p.167-178 |
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| creator | Sim, John J. Bhandari, Simran K. Batech, Michael Hever, Aviv Harrison, Teresa N. Shu, Yu-Hsiang Kujubu, Dean A. Jonelis, Tracy Y. Kanter, Michael H. Jacobsen, Steven J. |
| description | To compare renal function decline, incident end-stage renal disease (ESRD), and mortality among patients with 5 common glomerular diseases in a large diverse population.
A retrospective cohort study (between January 1, 2000, and December 31, 2011) of patients with glomerulonephropathy using the electronic health record of an integrated health system was performed. Estimated glomerular filtration rate (eGFR) change, incident ESRD, and mortality were compared among patients with biopsy-proven focal segmental glomerulosclerosis (FSGS), membranous glomerulonephritis (MN), minimal change disease (MCD), immunoglobulin A nephropathy (IgAN), and lupus nephritis (LN). Competing risk models were used to estimate hazard ratios for different glomerulonephropathies for incident ESRD, with mortality as a competing outcome after adjusting for potential confounders.
Of the 2350 patients with glomerulonephropathy (208 patients [9%] younger than 18 years) with a mean follow-up of 4.5±3.6 years, 497 (21%) progressed to ESRD and 195 (8%) died before ESRD. The median eGFR decline was 1.0 mL/min per 1.73 m2 per year but varied across different glomerulonephropathies (P |
| doi_str_mv | 10.1016/j.mayocp.2017.10.021 |
| format | Article |
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A retrospective cohort study (between January 1, 2000, and December 31, 2011) of patients with glomerulonephropathy using the electronic health record of an integrated health system was performed. Estimated glomerular filtration rate (eGFR) change, incident ESRD, and mortality were compared among patients with biopsy-proven focal segmental glomerulosclerosis (FSGS), membranous glomerulonephritis (MN), minimal change disease (MCD), immunoglobulin A nephropathy (IgAN), and lupus nephritis (LN). Competing risk models were used to estimate hazard ratios for different glomerulonephropathies for incident ESRD, with mortality as a competing outcome after adjusting for potential confounders.
Of the 2350 patients with glomerulonephropathy (208 patients [9%] younger than 18 years) with a mean follow-up of 4.5±3.6 years, 497 (21%) progressed to ESRD and 195 (8%) died before ESRD. The median eGFR decline was 1.0 mL/min per 1.73 m2 per year but varied across different glomerulonephropathies (P<.001). The highest ESRD incidence (per 100 person-years) was observed in FSGS 8.72 (95% CI, 3.93-16.72) followed by IgAN (4.54; 95% CI, 1.37-11.02), LN (2.38; 95% CI, 0.37-7.82), MN (2.15; 95% CI, 0.29-7.46), and MCD (1.67; 95% CI, 0.15-6.69). Compared with MCD, hazard ratios (95% CIs) for incident ESRD were 3.43 (2.32-5.08) and 2.35 (1.46-3.81), 1.28 (0.79-2.07), and 1.02 (0.62-1.68) for FSGS, IgAN, LN, and MN, respectively. No significant association between glomerulonephropathy types and mortality was detected (P=.24).
Our findings from a real-world clinical environment revealed significant differences in eGFR decline and ESRD risk among patients with 5 glomerulonephropathies. These variations in presentation and outcomes warrant different management strategies and expectations.</description><identifier>ISSN: 0025-6196</identifier><identifier>EISSN: 1942-5546</identifier><identifier>DOI: 10.1016/j.mayocp.2017.10.021</identifier><identifier>PMID: 29395351</identifier><language>eng</language><publisher>England: Elsevier Inc</publisher><subject>Adult ; Biopsy ; Biopsy - methods ; California - epidemiology ; Care and treatment ; Chronic kidney failure ; Cohort Studies ; Dialysis ; Electronic records ; End-stage renal disease ; Ethnic Groups ; Female ; Glomerular Filtration Rate ; Glomerulonephritis ; Glomerulonephritis - classification ; Glomerulonephritis - complications ; Glomerulonephritis - mortality ; Glomerulonephritis - physiopathology ; Humans ; Immunoglobulins ; Incidence ; Kidney diseases ; Kidney Failure, Chronic - diagnosis ; Kidney Failure, Chronic - epidemiology ; Kidney Failure, Chronic - etiology ; Kidney Glomerulus - pathology ; Kidney Glomerulus - physiopathology ; Lupus ; Male ; Middle Aged ; Mortality ; Patient Care Management - methods ; Peritoneal dialysis ; Population ; Proportional Hazards Models ; Risk Factors ; Survival Analysis</subject><ispartof>Mayo Clinic proceedings, 2018-02, Vol.93 (2), p.167-178</ispartof><rights>2017 Mayo Foundation for Medical Education and Research</rights><rights>Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.</rights><rights>COPYRIGHT 2018 Frontline Medical Communications Inc.</rights><rights>Copyright Mayo Foundation for Medical Education and Research Feb 2018</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c460t-58b873e7ddaa5001af37344a30aa93a9d2c3ca66a0a78f5c619de008b2dfd6323</citedby><cites>FETCH-LOGICAL-c460t-58b873e7ddaa5001af37344a30aa93a9d2c3ca66a0a78f5c619de008b2dfd6323</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2001004630?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29395351$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sim, John J.</creatorcontrib><creatorcontrib>Bhandari, Simran K.</creatorcontrib><creatorcontrib>Batech, Michael</creatorcontrib><creatorcontrib>Hever, Aviv</creatorcontrib><creatorcontrib>Harrison, Teresa N.</creatorcontrib><creatorcontrib>Shu, Yu-Hsiang</creatorcontrib><creatorcontrib>Kujubu, Dean A.</creatorcontrib><creatorcontrib>Jonelis, Tracy Y.</creatorcontrib><creatorcontrib>Kanter, Michael H.</creatorcontrib><creatorcontrib>Jacobsen, Steven J.</creatorcontrib><title>End-Stage Renal Disease and Mortality Outcomes Across Different Glomerulonephropathies in a Large Diverse US Population</title><title>Mayo Clinic proceedings</title><addtitle>Mayo Clin Proc</addtitle><description>To compare renal function decline, incident end-stage renal disease (ESRD), and mortality among patients with 5 common glomerular diseases in a large diverse population.
A retrospective cohort study (between January 1, 2000, and December 31, 2011) of patients with glomerulonephropathy using the electronic health record of an integrated health system was performed. Estimated glomerular filtration rate (eGFR) change, incident ESRD, and mortality were compared among patients with biopsy-proven focal segmental glomerulosclerosis (FSGS), membranous glomerulonephritis (MN), minimal change disease (MCD), immunoglobulin A nephropathy (IgAN), and lupus nephritis (LN). Competing risk models were used to estimate hazard ratios for different glomerulonephropathies for incident ESRD, with mortality as a competing outcome after adjusting for potential confounders.
Of the 2350 patients with glomerulonephropathy (208 patients [9%] younger than 18 years) with a mean follow-up of 4.5±3.6 years, 497 (21%) progressed to ESRD and 195 (8%) died before ESRD. The median eGFR decline was 1.0 mL/min per 1.73 m2 per year but varied across different glomerulonephropathies (P<.001). The highest ESRD incidence (per 100 person-years) was observed in FSGS 8.72 (95% CI, 3.93-16.72) followed by IgAN (4.54; 95% CI, 1.37-11.02), LN (2.38; 95% CI, 0.37-7.82), MN (2.15; 95% CI, 0.29-7.46), and MCD (1.67; 95% CI, 0.15-6.69). Compared with MCD, hazard ratios (95% CIs) for incident ESRD were 3.43 (2.32-5.08) and 2.35 (1.46-3.81), 1.28 (0.79-2.07), and 1.02 (0.62-1.68) for FSGS, IgAN, LN, and MN, respectively. No significant association between glomerulonephropathy types and mortality was detected (P=.24).
Our findings from a real-world clinical environment revealed significant differences in eGFR decline and ESRD risk among patients with 5 glomerulonephropathies. These variations in presentation and outcomes warrant different management strategies and expectations.</description><subject>Adult</subject><subject>Biopsy</subject><subject>Biopsy - methods</subject><subject>California - epidemiology</subject><subject>Care and treatment</subject><subject>Chronic kidney failure</subject><subject>Cohort Studies</subject><subject>Dialysis</subject><subject>Electronic records</subject><subject>End-stage renal disease</subject><subject>Ethnic Groups</subject><subject>Female</subject><subject>Glomerular Filtration Rate</subject><subject>Glomerulonephritis</subject><subject>Glomerulonephritis - classification</subject><subject>Glomerulonephritis - complications</subject><subject>Glomerulonephritis - mortality</subject><subject>Glomerulonephritis - physiopathology</subject><subject>Humans</subject><subject>Immunoglobulins</subject><subject>Incidence</subject><subject>Kidney diseases</subject><subject>Kidney Failure, Chronic - diagnosis</subject><subject>Kidney Failure, Chronic - epidemiology</subject><subject>Kidney Failure, Chronic - etiology</subject><subject>Kidney Glomerulus - pathology</subject><subject>Kidney Glomerulus - physiopathology</subject><subject>Lupus</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Patient Care Management - methods</subject><subject>Peritoneal dialysis</subject><subject>Population</subject><subject>Proportional Hazards Models</subject><subject>Risk Factors</subject><subject>Survival Analysis</subject><issn>0025-6196</issn><issn>1942-5546</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kVGL1DAUhYso7rj6D0QKgvjSmjRtOnkRht11FUZWXPc53EludzKkTTdJV-bfm9pV1AfJQ-Dw3XOTc7LsJSUlJZS_O5Q9HJ0ay4rQNkklqeijbEVFXRVNU_PH2YqQqik4FfwkexbCgRDSClE_zU4qwUTDGrrKvl8MuriOcIv5VxzA5ucmIATMYdD5Z-cjWBOP-dUUlesx5BvlXQiJ6jr0OMT80ibdT9YNOO69GyHuTeLMkEO-BZ98z809-uR4c51_ceNkIRo3PM-edGADvni4T7ObDxffzj4W26vLT2ebbaFqTmLRrHfrlmGrNUBDCIWOtayugREAwUDoSjEFnAOBdt01Kn1WIyHrXaU7zVnFTrO3i-_o3d2EIcreBIXWwoBuCpKKFIWoOW0T-vof9OAmnzIJskqrCak5I4kqF-oWLEozdC56UOlo7I1KKXQm6ZumErUgvJlt3_wxsEewcR-cneYUwt9gvYA_I_bYydGbHvxRUiLnyuVBLpXLufJZTZWnsVcPz552PerfQ786TsD7BcCU871BL4MyOCjUxqOKUjvz_w0_APurvgc</recordid><startdate>201802</startdate><enddate>201802</enddate><creator>Sim, John J.</creator><creator>Bhandari, Simran K.</creator><creator>Batech, Michael</creator><creator>Hever, Aviv</creator><creator>Harrison, Teresa N.</creator><creator>Shu, Yu-Hsiang</creator><creator>Kujubu, Dean A.</creator><creator>Jonelis, Tracy Y.</creator><creator>Kanter, Michael H.</creator><creator>Jacobsen, Steven J.</creator><general>Elsevier Inc</general><general>Frontline Medical Communications Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4U-</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>201802</creationdate><title>End-Stage Renal Disease and Mortality Outcomes Across Different Glomerulonephropathies in a Large Diverse US Population</title><author>Sim, John J. ; Bhandari, Simran K. ; Batech, Michael ; Hever, Aviv ; Harrison, Teresa N. ; Shu, Yu-Hsiang ; Kujubu, Dean A. ; Jonelis, Tracy Y. ; Kanter, Michael H. ; Jacobsen, Steven J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c460t-58b873e7ddaa5001af37344a30aa93a9d2c3ca66a0a78f5c619de008b2dfd6323</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Biopsy</topic><topic>Biopsy - methods</topic><topic>California - epidemiology</topic><topic>Care and treatment</topic><topic>Chronic kidney failure</topic><topic>Cohort Studies</topic><topic>Dialysis</topic><topic>Electronic records</topic><topic>End-stage renal disease</topic><topic>Ethnic Groups</topic><topic>Female</topic><topic>Glomerular Filtration Rate</topic><topic>Glomerulonephritis</topic><topic>Glomerulonephritis - classification</topic><topic>Glomerulonephritis - complications</topic><topic>Glomerulonephritis - mortality</topic><topic>Glomerulonephritis - physiopathology</topic><topic>Humans</topic><topic>Immunoglobulins</topic><topic>Incidence</topic><topic>Kidney diseases</topic><topic>Kidney Failure, Chronic - diagnosis</topic><topic>Kidney Failure, Chronic - epidemiology</topic><topic>Kidney Failure, Chronic - etiology</topic><topic>Kidney Glomerulus - pathology</topic><topic>Kidney Glomerulus - physiopathology</topic><topic>Lupus</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Patient Care Management - methods</topic><topic>Peritoneal dialysis</topic><topic>Population</topic><topic>Proportional Hazards Models</topic><topic>Risk Factors</topic><topic>Survival Analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sim, John J.</creatorcontrib><creatorcontrib>Bhandari, Simran K.</creatorcontrib><creatorcontrib>Batech, Michael</creatorcontrib><creatorcontrib>Hever, Aviv</creatorcontrib><creatorcontrib>Harrison, Teresa N.</creatorcontrib><creatorcontrib>Shu, Yu-Hsiang</creatorcontrib><creatorcontrib>Kujubu, Dean A.</creatorcontrib><creatorcontrib>Jonelis, Tracy Y.</creatorcontrib><creatorcontrib>Kanter, Michael H.</creatorcontrib><creatorcontrib>Jacobsen, Steven J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>University Readers</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>Immunology Abstracts</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>eLibrary</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Science Journals</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>Mayo Clinic proceedings</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sim, John J.</au><au>Bhandari, Simran K.</au><au>Batech, Michael</au><au>Hever, Aviv</au><au>Harrison, Teresa N.</au><au>Shu, Yu-Hsiang</au><au>Kujubu, Dean A.</au><au>Jonelis, Tracy Y.</au><au>Kanter, Michael H.</au><au>Jacobsen, Steven J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>End-Stage Renal Disease and Mortality Outcomes Across Different Glomerulonephropathies in a Large Diverse US Population</atitle><jtitle>Mayo Clinic proceedings</jtitle><addtitle>Mayo Clin Proc</addtitle><date>2018-02</date><risdate>2018</risdate><volume>93</volume><issue>2</issue><spage>167</spage><epage>178</epage><pages>167-178</pages><issn>0025-6196</issn><eissn>1942-5546</eissn><abstract>To compare renal function decline, incident end-stage renal disease (ESRD), and mortality among patients with 5 common glomerular diseases in a large diverse population.
A retrospective cohort study (between January 1, 2000, and December 31, 2011) of patients with glomerulonephropathy using the electronic health record of an integrated health system was performed. Estimated glomerular filtration rate (eGFR) change, incident ESRD, and mortality were compared among patients with biopsy-proven focal segmental glomerulosclerosis (FSGS), membranous glomerulonephritis (MN), minimal change disease (MCD), immunoglobulin A nephropathy (IgAN), and lupus nephritis (LN). Competing risk models were used to estimate hazard ratios for different glomerulonephropathies for incident ESRD, with mortality as a competing outcome after adjusting for potential confounders.
Of the 2350 patients with glomerulonephropathy (208 patients [9%] younger than 18 years) with a mean follow-up of 4.5±3.6 years, 497 (21%) progressed to ESRD and 195 (8%) died before ESRD. The median eGFR decline was 1.0 mL/min per 1.73 m2 per year but varied across different glomerulonephropathies (P<.001). The highest ESRD incidence (per 100 person-years) was observed in FSGS 8.72 (95% CI, 3.93-16.72) followed by IgAN (4.54; 95% CI, 1.37-11.02), LN (2.38; 95% CI, 0.37-7.82), MN (2.15; 95% CI, 0.29-7.46), and MCD (1.67; 95% CI, 0.15-6.69). Compared with MCD, hazard ratios (95% CIs) for incident ESRD were 3.43 (2.32-5.08) and 2.35 (1.46-3.81), 1.28 (0.79-2.07), and 1.02 (0.62-1.68) for FSGS, IgAN, LN, and MN, respectively. No significant association between glomerulonephropathy types and mortality was detected (P=.24).
Our findings from a real-world clinical environment revealed significant differences in eGFR decline and ESRD risk among patients with 5 glomerulonephropathies. These variations in presentation and outcomes warrant different management strategies and expectations.</abstract><cop>England</cop><pub>Elsevier Inc</pub><pmid>29395351</pmid><doi>10.1016/j.mayocp.2017.10.021</doi><tpages>12</tpages></addata></record> |
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| subjects | Adult Biopsy Biopsy - methods California - epidemiology Care and treatment Chronic kidney failure Cohort Studies Dialysis Electronic records End-stage renal disease Ethnic Groups Female Glomerular Filtration Rate Glomerulonephritis Glomerulonephritis - classification Glomerulonephritis - complications Glomerulonephritis - mortality Glomerulonephritis - physiopathology Humans Immunoglobulins Incidence Kidney diseases Kidney Failure, Chronic - diagnosis Kidney Failure, Chronic - epidemiology Kidney Failure, Chronic - etiology Kidney Glomerulus - pathology Kidney Glomerulus - physiopathology Lupus Male Middle Aged Mortality Patient Care Management - methods Peritoneal dialysis Population Proportional Hazards Models Risk Factors Survival Analysis |
| title | End-Stage Renal Disease and Mortality Outcomes Across Different Glomerulonephropathies in a Large Diverse US Population |
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