Biopsy-proven CKD etiology and outcomes: the Chronic Kidney Disease Japan Cohort (CKD-JAC) study. Issue 2 (22nd March 2022)

• Record Type: Journal Article
• Authors: Hamano, Takayuki; Imaizumi, Takahiro; Hasegawa, Takeshi; Fujii, Naohiko; Komaba, Hirotaka; Ando, Masahiko; Nangaku, Masaomi; Nitta, Kosaku; Hirakata, Hideki; Isaka, Yoshitaka; Wada, Takashi; Maruyama, Shoichi; Fukagawa, Masafumi
• Is Part Of: Nephrology dialysis transplantation. Volume 38:Issue 2(2023)
• Page Start: 384
• Page End: 395
• Publication Date: 2022-03-22
• Subjects: CKD -- diabetic kidney disease -- epidemiology -- kidney biopsy -- prognosis; Nephrology -- Periodicals; Hemodialysis -- Periodicals; Kidneys -- Transplantation -- Periodicals; Hemodialysis; Kidneys -- Transplantation; Nephrology; Periodicals; 616.61
• DOI: 10.1093/ndt/gfac134
• Languages: English
• ISSNs: 0931-0509

Abstract

ABSTRACT: Background: The Kidney Disease: Improving Global Outcomes guidelines advocate the cause–glomerular filtration rate (GFR)–albuminuria (CGA) classification for predicting outcomes. However, there is a dearth of data supporting the use of the cause of chronic kidney disease. This study aimed to address how to incorporate a prior biopsy-proven diagnosis in outcome prediction. Methods: We examined the association of biopsy-proven kidney disease diagnoses with kidney failure with replacement therapy (KFRT) and all-cause death before KFRT in patients with various biopsy-proven diagnoses ( n = 778, analysis A) and patients with diabetes mellitus labeled with biopsy-proven diabetic nephropathy (DN), other biopsy-proven diseases and no biopsy ( n = 1117, analysis B). Results: In analysis A, adding biopsy-proven diagnoses to the GFR–albuminuria (GA) classification improved the prediction of 8-year incidence of KFRT and all-cause death significantly regarding integrated discrimination improvement and net reclassification index. Fine–Gray (FG) models with KFRT as a competing event showed significantly higher subdistribution hazard ratios (SHRs) for all-cause death in nephrosclerosis {4.12 [95% confidence interval (CI) 1.11–15.2)], focal segmental glomerulosclerosis [3.77 (95% CI 1.09–13.1)]} and membranous nephropathy (MN) [2.91 (95% CI 1.02–8.30)] than in immunoglobulin A nephropathy (IgAN), while the Cox model failed to show significant associations. Crescentic glomerulonephritis had the highest risk of all-cause death [SHR 5.90 (95% CI 2.05–17.0)]. MN had a significantly lower risk of KFRT than IgAN [SHR 0.45 (95% CI 0.24–0.84)]. In analysis B, other biopsy-proven diseases had a lower risk of KFRT than biopsy-proven DN in the FG model, with death as a competing event [SHR 0.62 (95% CI 0.39–0.97)]. Conclusions: The CGA classification is of greater value in predicting outcomes than the GA classification. Graphical Abstract: