Abstract
Primary membranous nephropathy (PMN) is the predominant histological subtype of nephrotic syndrome in adults, exhibiting a wide range of prognostic outcomes. This study employed a retrospective cohort design to investigate patients with confirmed PMN diagnosis via renal biopsy at the Second People's Hospital of Shenzhen, Guangdong Province between January 2008 and March 2020, as well as at Hechi People's Hospital from June 2013 to September 2021. Utilizing regression analysis, survival analysis, and cross-examination, the study aimed to compare epidemiological characteristics and prognostic indicators among PMN patients across different geographic regions. The study included a cohort of 662 patients diagnosed with PMN, with 362 (54.7%) of these patients residing in Guangxi. Patients in Guangxi exhibited characteristics such as advanced age, a higher proportion of males, elevated systolic and diastolic blood pressure, increased levels of serum PLA2R antibody concentration, uric acid, total cholesterol, and urine protein, as well as lower levels of hemoglobin, serum albumin, and baseline estimated glomerular filtration rate (eGFR). Results from multivariate Cox analysis indicated that regional disparities were identified as independent risk factors for a 30% decline in eGFR among PMN patients, with the risk of reaching renal endpoint being 7.84 times higher in Guangxi compared to Guangdong. The KM curve analysis indicated a significantly higher incidence of reaching the renal endpoint in Guangxi (P<0.0001). Furthermore, the interaction test revealed significant regional variations in the impact on renal endpoint incidence across different eGFR quantiles, suggesting a notable interaction effect.
Conclusion: The clinical and pathological manifestations of primary membranous nephropathy (PMN) patients in Guangxi are more severe and have a worse renal prognosis compared to those in Shenzhen, Guangdong. Therefore, it is crucial to prioritize the allocation of limited medical resources and implement early intervention strategies in the formulation of chronic kidney disease health policies to effectively prevent and treat PMN in this region.