Long-term outcomes of end-stage kidney disease for patients with IgA nephropathy: a multi-centre registry study

Zhang, Lei, Liu, Xusheng, Pascoe, Elaine M., Badve, Sunil V., Boudville, Neil C., Clayton, Philip A., De Zoysa, Janak, Hawley, Carmel M., Kanellis, John, McDonald, Stephen P., Peh, Chen Au, Polkinghorne, Kevan R. and Johnson, David W. (2016) Long-term outcomes of end-stage kidney disease for patients with IgA nephropathy: a multi-centre registry study. Nephrology, 21 5: 387-396. doi:10.1111/nep.12629


Author Zhang, Lei
Liu, Xusheng
Pascoe, Elaine M.
Badve, Sunil V.
Boudville, Neil C.
Clayton, Philip A.
De Zoysa, Janak
Hawley, Carmel M.
Kanellis, John
McDonald, Stephen P.
Peh, Chen Au
Polkinghorne, Kevan R.
Johnson, David W.
Title Long-term outcomes of end-stage kidney disease for patients with IgA nephropathy: a multi-centre registry study
Journal name Nephrology   Check publisher's open access policy
ISSN 1440-1797
1320-5358
Publication date 2016-05-01
Year available 2016
Sub-type Article (original research)
DOI 10.1111/nep.12629
Open Access Status Not Open Access
Volume 21
Issue 5
Start page 387
End page 396
Total pages 10
Place of publication Richmond, VIC Australia
Publisher Wiley-Blackwell Publishing Asia
Collection year 2017
Language eng
Formatted abstract
Background
Clinical outcomes of patients with end-stage kidney disease (ESKD) receiving renal replacement therapy (RRT) secondary to IgA nephropathy (IgAN) have not been well described.

Aim
To investigate the characteristics, treatments and outcomes of ESKD because of kidney-limited IgAN and Henoch-Schönlein purpura nephritis (HSPN) in the Australian and New Zealand RRT populations.

Methods
All ESKD patients who commenced RRT in Australia and New Zealand between 1971 and 2012 were included. Dialysis and transplant outcomes were evaluated in both a contemporary cohort (1998–2012) and the entire cohort (1971–2012).

Results
Of 63 297 ESKD patients, 3721 had kidney-limited IgAN, and 131 had HSPN. For the contemporary cohort of IgAN patients on dialysis (n = 2194), 10-year patient survival was 65%. Of 1368 contemporary IgAN patients who received their first renal allograft, 10-year patient, overall renal allograft and death-censored renal allograft survival were 93%, 82% and 88%, respectively. Using multivariable Cox regression analysis, patients with IgAN had favourable dialysis patient survival (adjusted hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.57–0.69), overall renal allograft survival (HR 0.67, 95% CI 0.57–0.79) and renal transplant patient survival (HR 0.58, 95% CI 0.45–0.74) compared with ESKD controls. Similar results were found in the entire cohort and when using competing-risks models. Compared with kidney-limited IgAN patients, those with HSPN had worse dialysis patient survival (HR 1.94, 95% CI 1.02–3.69), overall renal allograft survival (HR 3.40, 95% CI 1.00–11.55) and renal transplant patient survival (HR 3.50, 95% CI 1.03–11.92).

Conclusion
IgAN ESKD was associated with better dialysis and renal transplant outcomes compared with other forms of ESKD. The survival outcomes of ESKD patients with HSPN were worse than kidney-limited IgAN.
Keyword Dialysis
End-stage kidney disease
Henoch-Schönlein purpura
IgA nephropathy
Outcomes
Renal transplantation
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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