Long-term outcomes of patients with end-stage kidney disease due to membranous nephropathy: A cohort study using the Australia and New Zealand Dialysis and Transplant Registry.
Adolescent
Adult
Aged
Allografts
Australia
Cohort Studies
Female
Glomerulonephritis, Membranous
/ complications
Graft Survival
Humans
Kidney
/ physiopathology
Kidney Failure, Chronic
/ etiology
Kidney Transplantation
Male
Middle Aged
New Zealand
Recurrence
Registries
Renal Dialysis
Survival Analysis
Time Factors
Treatment Outcome
Young Adult
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
22
04
2019
accepted:
08
08
2019
entrez:
24
8
2019
pubmed:
24
8
2019
medline:
4
3
2020
Statut:
epublish
Résumé
Clinical outcomes of patients with end-stage kidney disease (ESKD) secondary to membranous nephropathy (MN) have not been well described. This study aimed to evaluate patient and/or allograft outcomes of dialysis or kidney transplantation in patients with ESKD secondary to MN. All adult patients with ESKD commencing renal replacement therapy in Australia and New Zealand from January 1998 to December 2010 were extracted retrospectively from ANZDATA registry on 31st December 2013. Outcomes of MN were compared to other causes of ESKD. In a secondary analysis, outcomes of MN were compared to all patients with ESKD due to other forms of glomerulonephritis. Of 32,788 included patients, 417 (1.3%) had MN. Compared to other causes of ESKD, MN experienced lower mortality on dialysis (adjusted hazard ratio [aHR] 0.79, 95% CI 0.68-0.92, p = 0.002) and following kidney transplantation (aHR 0.57, 95% CI 0.33-0.97, p = 0.04), had a higher risk of death-censored kidney allograft failure (aHR 1.55, 95% CI: 1.00-2.41, p = 0.05) but comparable risk of overall kidney allograft failure (aHR 1.35, 95% CI 0.91-2.01, p = 0.13). Similar results were obtained using competing-risk regression analyses. MN patients were significantly more likely to receive a kidney transplant (aHR 1.38, 95% CI 1.16-1.63, p<0.001) and to experience primary kidney disease recurrence in the allograft (aHR 4.92, 95% CI 3.02-8.01, p<0.001). Compared to other forms of glomerulonephritis, MN experienced comparable dialysis and transplant patient survival, but higher rates of kidney transplantation, primary renal disease recurrence and death-censored allograft failure. MN was associated with superior survival on dialysis and following kidney transplantation compared to patients with other causes of ESKD, and comparable patient survival compared to patients with other forms of glomerulonephritis. However, patients with MN exhibited a higher rate of death-censored allograft loss as a result of primary kidney disease recurrence.
Sections du résumé
BACKGROUND
Clinical outcomes of patients with end-stage kidney disease (ESKD) secondary to membranous nephropathy (MN) have not been well described. This study aimed to evaluate patient and/or allograft outcomes of dialysis or kidney transplantation in patients with ESKD secondary to MN.
MATERIAL AND METHODS
All adult patients with ESKD commencing renal replacement therapy in Australia and New Zealand from January 1998 to December 2010 were extracted retrospectively from ANZDATA registry on 31st December 2013. Outcomes of MN were compared to other causes of ESKD. In a secondary analysis, outcomes of MN were compared to all patients with ESKD due to other forms of glomerulonephritis.
RESULTS
Of 32,788 included patients, 417 (1.3%) had MN. Compared to other causes of ESKD, MN experienced lower mortality on dialysis (adjusted hazard ratio [aHR] 0.79, 95% CI 0.68-0.92, p = 0.002) and following kidney transplantation (aHR 0.57, 95% CI 0.33-0.97, p = 0.04), had a higher risk of death-censored kidney allograft failure (aHR 1.55, 95% CI: 1.00-2.41, p = 0.05) but comparable risk of overall kidney allograft failure (aHR 1.35, 95% CI 0.91-2.01, p = 0.13). Similar results were obtained using competing-risk regression analyses. MN patients were significantly more likely to receive a kidney transplant (aHR 1.38, 95% CI 1.16-1.63, p<0.001) and to experience primary kidney disease recurrence in the allograft (aHR 4.92, 95% CI 3.02-8.01, p<0.001). Compared to other forms of glomerulonephritis, MN experienced comparable dialysis and transplant patient survival, but higher rates of kidney transplantation, primary renal disease recurrence and death-censored allograft failure.
CONCLUSION
MN was associated with superior survival on dialysis and following kidney transplantation compared to patients with other causes of ESKD, and comparable patient survival compared to patients with other forms of glomerulonephritis. However, patients with MN exhibited a higher rate of death-censored allograft loss as a result of primary kidney disease recurrence.
Identifiants
pubmed: 31442267
doi: 10.1371/journal.pone.0221531
pii: PONE-D-19-10701
pmc: PMC6707602
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0221531Déclaration de conflit d'intérêts
DJ has received consultancy fees, research grants, speaker’s honoraria and travel sponsorships from Baxter Healthcare (https://www.baxterhealthcare.com.au), Fresenius Medical Care (https://www.fmc-au.com/) and Amgen (www.amgen.com.au) Australia Pty Ltd. He is supported by a National Health and Medical Research Council (NHMRC) Practitioner Fellowship. YC has received research grants from Baxter Healthcare (https://www.baxterhealthcare.com.au) and Fresenius Medical Care (https://www.fmc-au.com/). She is supported by a NHMRC early career fellowship. CH has received research grants form Baxter Health (https://www.baxterhealthcare.com.au), Fresenius Medical Care (https://www.fmc-au.com/) and Amgen (www.amgen.com.au). All others have no competing interests to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
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