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024 7 _ |a 10.1681/ASN.2020030349
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024 7 _ |a 1046-6673
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024 7 _ |a 1533-3450
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037 _ _ |a DKFZ-2021-00452
041 _ _ |a eng
082 _ _ |a 610
100 1 _ |a Canney, Mark
|0 0000-0002-4308-3083
|b 0
245 _ _ |a Quantifying Duration of Proteinuria Remission and Association with Clinical Outcome in IgA Nephropathy.
260 _ _ |a [S.l.]
|c 2021
|b Ovid
336 7 _ |a article
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336 7 _ |a Journal Article
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336 7 _ |a ARTICLE
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336 7 _ |a JOURNAL_ARTICLE
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336 7 _ |a Journal Article
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500 _ _ |a Groene H (MD, Department of Cellular and Molecular Pathology, German Cancer Research Center, Heidelberg, Germany)
520 _ _ |a On 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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588 _ _ |a Dataset connected to CrossRef, PubMed,
650 _ 7 |a IgA nephropathy
|2 Other
650 _ 7 |a end stage kidney disease
|2 Other
650 _ 7 |a epidemiology and outcomes
|2 Other
650 _ 7 |a glomerular disease
|2 Other
650 _ 7 |a proteinuria
|2 Other
650 _ 7 |a renal function decline
|2 Other
650 _ 7 |a renal pathology
|2 Other
700 1 _ |a Barbour, Sean J
|b 1
700 1 _ |a Zheng, Yuyan
|b 2
700 1 _ |a Coppo, Rosanna
|b 3
700 1 _ |a Zhang, Hong
|b 4
700 1 _ |a Liu, Zhi-Hong
|b 5
700 1 _ |a Matsuzaki, Keiichi
|b 6
700 1 _ |a Suzuki, Yusuke
|b 7
700 1 _ |a Katafuchi, Ritsuko
|b 8
700 1 _ |a Reich, Heather N
|b 9
700 1 _ |a Cattran, Daniel
|b 10
700 1 _ |a Network, International IgA Nephropathy
|b 11
|e Collaboration Author
700 1 _ |a Investigators, International IgA Nephropathy Network
|b 12
|e Collaboration Author
700 1 _ |a Russo, M. L.
|b 13
700 1 _ |a Troyanov, S.
|b 14
700 1 _ |a Cook, H. T.
|b 15
700 1 _ |a Roberts, I.
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700 1 _ |a Tesar, V.
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773 _ _ |a 10.1681/ASN.2020030349
|g Vol. 32, no. 2, p. 436 - 447
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|t Journal of the American Society of Nephrology
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