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000167605 0247_ $$2doi$$a10.1681/ASN.2020030349
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000167605 1001_ $$00000-0002-4308-3083$$aCanney, Mark$$b0
000167605 245__ $$aQuantifying Duration of Proteinuria Remission and Association with Clinical Outcome in IgA Nephropathy.
000167605 260__ $$a[S.l.]$$bOvid$$c2021
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000167605 500__ $$aGroene H (MD, Department of Cellular and Molecular Pathology, German Cancer Research Center, Heidelberg, Germany)
000167605 520__ $$aOn the basis of findings of observational studies and a meta-analysis, proteinuria reduction has been proposed as a surrogate outcome in IgA nephropathy. How long a reduction in proteinuria needs to be maintained to mitigate the long-term risk of disease progression is unknown.In this retrospective multiethnic cohort of adult patients with IgA nephropathy, we defined proteinuria remission as a ≥25% reduction in proteinuria from the peak value after biopsy, and an absolute reduction in proteinuria to <1 g/d. The exposure of interest was the total duration of first remission, treated as a time-varying covariate using longitudinal proteinuria measurements. We used time-dependent Cox proportional hazards regression models to quantify the association between the duration of remission and the primary outcome (ESKD or a 50% reduction in eGFR).During a median follow-up of 3.9 years, 274 of 1864 patients (14.7%) experienced the primary outcome. The relationship between duration of proteinuria remission and outcome was nonlinear. Each 3 months in sustained remission up to approximately 4 years was associated with an additional 9% reduction in the risk of disease progression (hazard ratio [HR], 0.91; 95% confidence interval [95% CI], 0.89 to 0.93). Thereafter, each additional 3 months in remission was associated with a smaller, nonsignificant risk reduction (HR, 0.99; 95% CI, 0.96 to 1.03). These findings were robust to multivariable adjustment and consistent across clinical and histologic subgroups.Our findings support the use of proteinuria as a surrogate outcome in IgA nephropathy, but additionally demonstrate the value of quantifying the duration of proteinuria remission when estimating the risk of hard clinical endpoints.
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000167605 650_7 $$2Other$$aIgA nephropathy
000167605 650_7 $$2Other$$aend stage kidney disease
000167605 650_7 $$2Other$$aepidemiology and outcomes
000167605 650_7 $$2Other$$aglomerular disease
000167605 650_7 $$2Other$$aproteinuria
000167605 650_7 $$2Other$$arenal function decline
000167605 650_7 $$2Other$$arenal pathology
000167605 7001_ $$aBarbour, Sean J$$b1
000167605 7001_ $$aZheng, Yuyan$$b2
000167605 7001_ $$aCoppo, Rosanna$$b3
000167605 7001_ $$aZhang, Hong$$b4
000167605 7001_ $$aLiu, Zhi-Hong$$b5
000167605 7001_ $$aMatsuzaki, Keiichi$$b6
000167605 7001_ $$aSuzuki, Yusuke$$b7
000167605 7001_ $$aKatafuchi, Ritsuko$$b8
000167605 7001_ $$aReich, Heather N$$b9
000167605 7001_ $$aCattran, Daniel$$b10
000167605 7001_ $$aNetwork, International IgA Nephropathy$$b11$$eCollaboration Author
000167605 7001_ $$aInvestigators, International IgA Nephropathy Network$$b12$$eCollaboration Author
000167605 7001_ $$aRusso, M. L.$$b13
000167605 7001_ $$aTroyanov, S.$$b14
000167605 7001_ $$aCook, H. T.$$b15
000167605 7001_ $$aRoberts, I.$$b16
000167605 7001_ $$aTesar, V.$$b17
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000167605 7001_ $$aPeruzzi, L.$$b26
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000167605 7001_ $$aRavera, S.$$b36
000167605 7001_ $$aDurlik, M.$$b37
000167605 7001_ $$aMoggia, E.$$b38
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000167605 7001_ $$aDi Giulio, S.$$b40
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000167605 773__ $$0PERI:(DE-600)2029124-3$$a10.1681/ASN.2020030349$$gVol. 32, no. 2, p. 436 - 447$$n2$$p436 - 447$$tJournal of the American Society of Nephrology$$v32$$x1533-3450$$y2021
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