Long-term outcomes of adults with FSGS in the German Chronic Kidney Disease cohort.

Autor: Stamellou E; Division of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany.; Department of Nephrology, School of Medicine, University of Ioannina, Ioannina, Greece., Nadal J; Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University Hospital Bonn, Bonn, Germany., Hendry B; Travere Therapeutics , Inc., San Diego, CA, USA., Mercer A; JAMCO Pharma Consulting, Enskede, Sweden., Bechtel-Walz W; Department of Medicine IV, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.; Berta-Ottenstein Program, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany., Schiffer M; Department of Nephrology and Hypertension, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany., Eckardt KU; Department of Nephrology and Hypertension, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany.; Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany., Kramann R; Division of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany., Moeller MJ; Division of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany., Floege J; Division of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany.; Department of Cardiology, RWTH Aachen University Hospital, Aachen, Germany.
Jazyk: angličtina
Zdroj: Clinical kidney journal [Clin Kidney J] 2024 Apr 27; Vol. 17 (7), pp. sfae131. Date of Electronic Publication: 2024 Apr 27 (Print Publication: 2024).
DOI: 10.1093/ckj/sfae131
Abstrakt: Background: Focal segmental glomerulosclerosis (FSGS) can lead to kidney failure in adults. This study examines the progression of FSGS in the German Chronic Kidney Disease (GCKD) cohort.
Methods: The GCKD study ( N  = 5217), a prospective cohort, included 159 patients with biopsy-confirmed FSGS recruited from 2010 to 2012. Baseline was defined as the first study visit. Adjudicated endpoints included a composite kidney endpoint (CKE), including an estimated glomerular filtration rate (eGFR) decrease >40%, eGFR <15 ml/min/1.73 m 2 or initiation of kidney replacement therapy and combined major adverse cardiovascular events (MACE), including non-fatal myocardial infarction or stroke and all-cause mortality. Associations between baseline demographics, laboratory data, comorbidity and CKE and MACE were analysed using the Cox proportional hazards regression model.
Results: The mean age at baseline was 52.1 ± 13.6 years, with a disease duration of 4.72 years (quartile 1: 1; quartile 3: 6) before joining the study. The median urinary albumin:creatinine ratio (UACR) at baseline was 0.7 g/g (IQR 0.1;1.8), while mean eGFR was 55.8 ± 23 ml/min/1.73 m 2 . Based on clinical and pathological features, 69 (43.4%) patients were categorized as primary FSGS, 55 (34.6%) as secondary FSGS and 35 (22%) as indeterminate. Over a follow-up of 6.5 years, 44 patients reached the composite kidney endpoint and 16 individuals had at least one MACE. UACR ≥0.7 g/g was strongly associated with both the composite kidney endpoint {hazard ratio [HR] 5.27 [95% confidence interval (CI) 2.4-11.5]} and MACE [HR 3.37 (95% CI 1.05-10.82)] compared with <0.7 g/g, whereas a higher eGFR at baseline (per 10 ml/min) was protective for both endpoints [HR 0.8 (95% CI 0.68-0.95) and HR 0.63 (95% CI 0.46-0.88), respectively]. Patients with secondary FSGS experienced a greater rate of eGFR decline than patients with primary FSGS.
Conclusions: Lower eGFR and higher albuminuria are key risk factors for kidney disease progression and cardiovascular events in patients with FSGS.
Competing Interests: J.F. is the Editor-in-Chief of CKJ.
(© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)
Databáze: MEDLINE
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