Long-term outcomes of adults with FSGS in the German Chronic Kidney Disease cohort
Author:
Stamellou Eleni12ORCID, Nadal Jennifer3, Hendry Bruce45, Mercer Alex6, Bechtel-Walz Wibke78, Schiffer Mario9, Eckardt Kai-Uwe910ORCID, Kramann Rafael1ORCID, Moeller Marcus J1, Floege Jürgen111, Eckardt Kai-Uwe, Meiselbach Heike, Schneider Markus P, Schiffer Mario, Prokosch Hans-Ulrich, Bärthlein Barbara, Beck Andreas, Reis André, Ekici Arif B, Becker Susanne, Alberth-Schmidt Ulrike, Marschall Sabine, Weigel Anke, Walz Gerd, Köttgen Anna, Schultheiß Ulla T, Kotsis Fruzsina, Meder Simone, Mitsch Erna, Reinhard Ursula, Floege Jürgen, Saritas Turgay, Schaeffner Elke, Baid-Agrawal Seema, Theisen Kerstin, Schmidt-Ott Kai, Zeier Martin, Sommerer Claudia, Aykac Mehtap, Wolf Gunter, Busch Martin, Steiner Andi, Sitter Thomas, Wanner Christoph, Krane Vera, Bauer Britta, Kronenberg Florian, Raschenberger Julia, Kollerits Barbara, Forer Lukas, Schönherr Sebastian, Weissensteiner Hansi, Oefner Peter, Gronwald Wolfram, Schmid Matthias, Nadal Jennifer,
Affiliation:
1. Division of Nephrology and Clinical Immunology, RWTH Aachen University Hospital , Aachen , Germany 2. Department of Nephrology, School of Medicine, University of Ioannina , Ioannina , Greece 3. Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University Hospital Bonn , Bonn , Germany 4. Travere Therapeutics , San Diego, CA , USA 5. , Inc. , San Diego, CA , USA 6. JAMCO Pharma Consulting , Enskede , Sweden 7. Department of Medicine IV, University Medical Center, Faculty of Medicine, University of Freiburg , Freiburg im Breisgau , Germany 8. Berta-Ottenstein Program, Faculty of Medicine, University of Freiburg , Freiburg im Breisgau , Germany 9. Department of Nephrology and Hypertension, Friedrich-Alexander Universität Erlangen-Nürnberg , Erlangen , Germany 10. Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin , Berlin , Germany 11. Department of Cardiology, RWTH Aachen University Hospital , Aachen , Germany
Abstract
ABSTRACT
Background
Focal segmental glomerulosclerosis (FSGS) can lead to kidney failure in adults. This study examines the progression of FSGS in the German Chronic Kidney Disease (GCKD) cohort.
Methods
The GCKD study (N = 5217), a prospective cohort, included 159 patients with biopsy-confirmed FSGS recruited from 2010 to 2012. Baseline was defined as the first study visit. Adjudicated endpoints included a composite kidney endpoint (CKE), including an estimated glomerular filtration rate (eGFR) decrease >40%, eGFR <15 ml/min/1.73 m2 or initiation of kidney replacement therapy and combined major adverse cardiovascular events (MACE), including non-fatal myocardial infarction or stroke and all-cause mortality. Associations between baseline demographics, laboratory data, comorbidity and CKE and MACE were analysed using the Cox proportional hazards regression model.
Results
The mean age at baseline was 52.1 ± 13.6 years, with a disease duration of 4.72 years (quartile 1: 1; quartile 3: 6) before joining the study. The median urinary albumin:creatinine ratio (UACR) at baseline was 0.7 g/g (IQR 0.1;1.8), while mean eGFR was 55.8 ± 23 ml/min/1.73 m2. Based on clinical and pathological features, 69 (43.4%) patients were categorized as primary FSGS, 55 (34.6%) as secondary FSGS and 35 (22%) as indeterminate. Over a follow-up of 6.5 years, 44 patients reached the composite kidney endpoint and 16 individuals had at least one MACE. UACR ≥0.7 g/g was strongly associated with both the composite kidney endpoint {hazard ratio [HR] 5.27 [95% confidence interval (CI) 2.4–11.5]} and MACE [HR 3.37 (95% CI 1.05–10.82)] compared with <0.7 g/g, whereas a higher eGFR at baseline (per 10 ml/min) was protective for both endpoints [HR 0.8 (95% CI 0.68–0.95) and HR 0.63 (95% CI 0.46–0.88), respectively]. Patients with secondary FSGS experienced a greater rate of eGFR decline than patients with primary FSGS.
Conclusions
Lower eGFR and higher albuminuria are key risk factors for kidney disease progression and cardiovascular events in patients with FSGS.
Funder
Bundesministerium für Bildung und Forschung Deutsche Forschungsgemeinschaft
Publisher
Oxford University Press (OUP)
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