Comparison of Patients with Hospital-Recorded Nephrotic Syndrome and Patients with Nephrotic Proteinuria and Hypoalbuminemia: A Nationwide Study in Denmark.
albuminuria
algorithms
epidemiology
glomerular and tubulointerstitial diseases
hospital records
hypoalbuminemia
nephrotic syndrome
proteinuria
Journal
Kidney360
ISSN: 2641-7650
Titre abrégé: Kidney360
Pays: United States
ID NLM: 101766381
Informations de publication
Date de publication:
30 09 2021
30 09 2021
Historique:
received:
22
01
2021
accepted:
28
05
2021
entrez:
4
4
2022
pubmed:
5
4
2022
medline:
8
4
2022
Statut:
epublish
Résumé
Registry-based studies of nephrotic syndrome (NS) may only include a subset of patients with biochemical features of NS. To address this, we compared patients with laboratory-recorded nephrotic proteinuria and hypoalbuminemia to patients with hospital-recorded NS. We identified adult patients with first-time hospital-recorded NS (inpatients, outpatients, or emergency-room visitors) in the Danish National Patient Registry and compared them with adults with first-time recorded nephrotic proteinuria and hypoalbuminemia in Danish laboratory databases during 2004-2018, defining the date of admission or laboratory findings as the index date. We characterized these cohorts by demographics, comorbidity, medication use, and laboratory and histopathologic findings. We identified 1139 patients with hospital-recorded NS and 5268 patients with nephrotic proteinuria and hypoalbuminemia; of these, 760 patients were identified in both cohorts. Within 1 year of the first record of nephrotic proteinuria and hypoalbuminemia, 18% had recorded hospital diagnoses indicating the presence of NS, and 87% had diagnoses reflecting any kind of nephropathy. Among patients identified with nephrotic proteinuria and hypoalbuminemia, their most recent eGFR was substantially lower (median of 35 versus 61 ml/min per 1.73 m Patients with nephrotic proteinuria and hypoalbuminemia are five-fold more common than patients with hospital-recorded NS, and they have a lower eGFR and more comorbidities. Selective and incomplete recording of NS may be an important issue when designing and interpreting studies of risks and prognosis of NS.
Sections du résumé
Background
Registry-based studies of nephrotic syndrome (NS) may only include a subset of patients with biochemical features of NS. To address this, we compared patients with laboratory-recorded nephrotic proteinuria and hypoalbuminemia to patients with hospital-recorded NS.
Methods
We identified adult patients with first-time hospital-recorded NS (inpatients, outpatients, or emergency-room visitors) in the Danish National Patient Registry and compared them with adults with first-time recorded nephrotic proteinuria and hypoalbuminemia in Danish laboratory databases during 2004-2018, defining the date of admission or laboratory findings as the index date. We characterized these cohorts by demographics, comorbidity, medication use, and laboratory and histopathologic findings.
Results
We identified 1139 patients with hospital-recorded NS and 5268 patients with nephrotic proteinuria and hypoalbuminemia; of these, 760 patients were identified in both cohorts. Within 1 year of the first record of nephrotic proteinuria and hypoalbuminemia, 18% had recorded hospital diagnoses indicating the presence of NS, and 87% had diagnoses reflecting any kind of nephropathy. Among patients identified with nephrotic proteinuria and hypoalbuminemia, their most recent eGFR was substantially lower (median of 35 versus 61 ml/min per 1.73 m
Conclusions
Patients with nephrotic proteinuria and hypoalbuminemia are five-fold more common than patients with hospital-recorded NS, and they have a lower eGFR and more comorbidities. Selective and incomplete recording of NS may be an important issue when designing and interpreting studies of risks and prognosis of NS.
Identifiants
pubmed: 35373110
doi: 10.34067/KID.0000362021
pii: 02200512-202109000-00014
pmc: PMC8786138
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1482-1490Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 by the American Society of Nephrology.
Déclaration de conflit d'intérêts
S.V. Vestergaard, H. Birn, A.T. Hansen, M. Nørgaard, and C.F. Christiansen have no personal conflicts of interest to declare regarding this study. The Department of Clinical Epidemiology, The Department of Biomedicine, and the Department of Renal Medicine are involved in studies with funding from various companies as research grants to (and administered by) Aarhus University or Aarhus University Hospital. None of these studies are related to this study. D. Nitsch is on the steering group for two GlaxoSmithKline-funded studies of kidney function in sub-Saharan Africa, unrelated to the work in this paper.
Références
Hull RP, Goldsmith DJ: Nephrotic syndrome in adults. BMJ 336: 1185–1189, 2008
Yu ASL, Skorecki K, Marsden PA, Chertow GM, Taal MW: Brenner & Rector’s The kidney, 10th Ed., Amsterdam, Elsevier, 2015
Cameron JS: Nephrotic syndrome in the elderly. Semin Nephrol 16: 319–329, 1996
Lin SY, Hsu WH, Lin CL, Lin CC, Lin CH, Wang IK, Hsu CY, Kao CH: Association of exposure to fine-particulate air pollution and acidic gases with incidence of nephrotic syndrome. Int J Environ Res Public Health 15: 2860, 2018
Christiansen CF, Schmidt M, Lamberg AL, Horváth-Puhó E, Baron JA, Jespersen B, Sørensen HT: Kidney disease and risk of venous thromboembolism: A nationwide population-based case-control study. J Thromb Haemost 12: 1449–1454, 2014
Yamamoto R, Imai E, Maruyama S, Yokoyama H, Sugiyama H, Nitta K, Tsukamoto T, Uchida S, Takeda A, Sato T, Wada T, Hayashi H, Akai Y, Fukunaga M, Tsuruya K, Masutani K, Konta T, Shoji T, Hiramatsu T, Goto S, Tamai H, Nishio S, Shirasaki A, Nagai K, Yamagata K, Hasegawa H, Yasuda H, Ichida S, Naruse T, Fukami K, Nishino T, Sobajima H, Tanaka S, Akahori T, Ito T, Yoshio T, Katafuchi R, Fujimoto S, Okada H, Ishimura E, Kazama JJ, Hiromura K, Mimura T, Suzuki S, Saka Y, Sofue T, Suzuki Y, Shibagaki Y, Kitagawa K, Morozumi K, Fujita Y, Mizutani M, Shigematsu T, Kashihara N, Sato H, Matsuo S, Narita I, Isaka Y: Regional variations in immunosuppressive therapy in patients with primary nephrotic syndrome: The Japan nephrotic syndrome cohort study. Clin Exp Nephrol 22: 1266–1280, 2018
Haas M, Meehan SM, Karrison TG, Spargo BH: Changing etiologies of unexplained adult nephrotic syndrome: A comparison of renal biopsy findings from 1976–1979 and 1995–1997. Am J Kidney Dis 30: 621–631, 1997
Mahmoodi BK, ten Kate MK, Waanders F, Veeger NJ, Brouwer JL, Vogt L, Navis G, van der Meer J: High absolute risks and predictors of venous and arterial thromboembolic events in patients with nephrotic syndrome: Results from a large retrospective cohort study.Circulation 117: 224–230, 2008
Kolb A, Gallacher PJ, Campbell J, O’Neill M, Smith JR, Bell S, Conway BR, Metcalfe W, Joss N, Dey V, Alfonzo A, Kelly M, Shah S, McQuarrie E, Geddes C, Traynor J, Hunter RW; Scottish Renal Biopsy Registry: A national registry study of patient and renal survival in adult nephrotic syndrome. Kidney Int Rep 6: 449–459, 2021
Shinkawa K, Yoshida S, Seki T, Yanagita M, Kawakami K: Risk factors of venous thromboembolism in patients with nephrotic syndrome: a retrospective cohort study [published online ahead of print July 13, 2020]. Nephrol Dial Transplant
Glassock RJ, Fervenza FC, Hebert L, Cameron JS: Nephrotic syndrome redux. Nephrol Dial Transplant 30: 12–17, 2015
Schmidt M, Schmidt SAJ, Adelborg K, Sundbøll J, Laugesen K, Ehrenstein V, Sørensen HT: The Danish health care system and epidemiological research: From health care contacts to database records. Clin Epidemiol 11: 563–591, 2019
Arendt JFH, Hansen AT, Ladefoged SA, Sørensen HT, Pedersen L, Adelborg K: Existing data sources in clinical epidemiology: Laboratory information system databases in Denmark. Clin Epidemiol 12: 469–475, 2020
Schmidt M, Pedersen L, Sørensen HT: The Danish Civil Registration System as a tool in epidemiology. Eur J Epidemiol 29: 541–549, 2014
Schmidt M, Schmidt SA, Sandegaard JL, Ehrenstein V, Pedersen L, Sørensen HT: The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol 7: 449–490, 2015
Grann AF, Erichsen R, Nielsen AG, Frøslev T, Thomsen RW: Existing data sources for clinical epidemiology: The clinical laboratory information system (LABKA) research database at Aarhus University, Denmark. Clin Epidemiol 3: 133–138, 2011
Kidney Disease Improving Global Outcomes (KDIGO) Glomerulonephritis Work Group: KDIGO clinical practice guideline for glomerulonephritis, 2012. Available at: https://kdigo.org/wp-content/uploads/2017/02/KDIGO-2012-GN-Guideline-English.pdf . Accessed August 3, 2021 2012
National Institute for Health and Care Excellence (NICE): Chronic kidney disease in adults: Assessment and management. Clinical guideline [CG182], 2014. Available at: https://www.nice.org.uk/guidance/cg182 . Accessed April 23, 2020
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J; CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration): A new equation to estimate glomerular filtration rate. Ann Intern Med 150: 604–612, 2009
Pottegård A, Schmidt SAJ, Wallach-Kildemoes H, Sørensen HT, Hallas J, Schmidt M: Data Resource Profile: The Danish National Prescription Registry. Int J Epidemiol 46: 798–798f, 2017
Erichsen R, Lash TL, Hamilton-Dutoit SJ, Bjerregaard B, Vyberg M, Pedersen L: Existing data sources for clinical epidemiology: The Danish National Pathology Registry and Data Bank. Clin Epidemiol 2: 51–56, 2010
Yamamoto R, Imai E, Maruyama S, Yokoyama H, Sugiyama H, Nitta K, Tsukamoto T, Uchida S, Takeda A, Sato T, Wada T, Hayashi H, Akai Y, Fukunaga M, Tsuruya K, Masutani K, Konta T, Shoji T, Hiramatsu T, Goto S, Tamai H, Nishio S, Shirasaki A, Nagai K, Yamagata K, Hasegawa H, Yasuda H, Ichida S, Naruse T, Nishino T, Sobajima H, Tanaka S, Akahori T, Ito T, Terada Y, Katafuchi R, Fujimoto S, Okada H, Ishimura E, Kazama JJ, Hiromura K, Mimura T, Suzuki S, Saka Y, Sofue T, Suzuki Y, Shibagaki Y, Kitagawa K, Morozumi K, Fujita Y, Mizutani M, Shigematsu T, Kashihara N, Sato H, Matsuo S, Narita I, Isaka Y: Incidence of remission and relapse of proteinuria, end-stage kidney disease, mortality, and major outcomes in primary nephrotic syndrome: The Japan Nephrotic Syndrome Cohort Study (JNSCS). Clin Exp Nephrol 24: 526–540, 2020
Dumas De La Roque C, Prezelin-Reydit M, Vermorel A, Lepreux S, Deminière C, Combe C, Rigothier C: Idiopathic nephrotic syndrome: Characteristics and identification of prognostic factors. J Clin Med 7: 265, 2018
Waldman M, Crew RJ, Valeri A, Busch J, Stokes B, Markowitz G, D’Agati V, Appel G: Adult minimal-change disease: Clinical characteristics, treatment, and outcomes. Clin J Am Soc Nephrol 2: 445–453, 2007
Stoycheff N, Stevens LA, Schmid CH, Tighiouart H, Lewis J, Atkins RC, Levey AS: Nephrotic syndrome in diabetic kidney disease: An evaluation and update of the definition. Am J Kidney Dis 54: 840–849, 2009
Methven S, MacGregor MS, Traynor JP, O’Reilly DSJ, Deighan CJ: Assessing proteinuria in chronic kidney disease: protein-creatinine ratio versus albumin-creatinine ratio. Nephrol Dial Transplant 25: 2991–2996, 2010
Price CP, Newall RG, Boyd JC: Use of protein:creatinine ratio measurements on random urine samples for prediction of significant proteinuria: a systematic review. Clin Chem 51: 1577–1586, 2005
Kidney Disease Improving Global Outcomes (KDIGO) CKD Work Group: KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Inter Suppl 3: 136–150, 2013. Available at: https://kdigo.org/wp-content/uploads/2017/02/KDIGO_2012_CKD_GL.pdf . Accessed August 03, 2021