Interpretation of GFR slope in untreated and treated adult Fabry patients

Author:

Pisani Antonio1,Pieruzzi Federico23,Cirami Calogero Lino4,Riccio Eleonora1,Mignani Renzo5

Affiliation:

1. Chair of Nephrology, Department of Public Health, Federico II University of Naples , Naples , Italy

2. Clinical Nephrology, Fondazione IRCCS San Gerardo dei Tintori , Monza , Italy

3. School of Medicine and Surgery, University of Milano-Bicocca , Milan , Italy

4. Nephrology Dialysis Transplant Unit, Careggi Hospital , Florence , Italy

5. Nephrology, Dialysis and Transplantation, IRCCS S. Orsola University Hospital, University of Bologna , Bologna , Italy

Abstract

ABSTRACT Nephropathy is one of the main features of Fabry disease (FD) that leads, in untreated patients with classical mutations, to end-stage renal disease (ESRD) from the third to the fifth decade of life. The availability of a specific treatment modified the natural history of FD; in particular, it was widely reported that enzyme replacement therapy (ERT) is able to slow the progression of the disease. Regarding Fabry nephropathy, several reports have documented an elevated estimated glomerular filtration rate (eGFR) slope in untreated patients as expression of a rapid disease progression towards ESRD. Otherwise, the prompt start of treatment may be beneficial in stabilizing renal function or slowing its decline. Therefore, based on data in the literature about the effects of ERT on eGFR decline and on the evidence supporting the role of eGFR slope as a surrogate endpoint for chronic kidney disease progression, we suggest, in this ‘Expert Opinion’, that a treatment should be defined effective when eGFR decline is <1 ml/min/1.73 m2/year and not effective when eGFR loss remains ≥3 ml/min/1.73 m2/year (≥2.5 ml/min/1.73 m2/year in females). Moreover, practical clinical recommendations and guidance for Fabry patients suggests that a change in treatment may be appropriate if individualized therapeutic goals are not achieved. Since a dose-dependent efficacy has been demonstrated for ERT, we suggest considering a switch to a higher dose of ERT in symptomatic adult Fabry patients (ages 18–60 years) with an eGFR of 45–90 ml/min/1.73 m2 and treated with a stable dose of ERT for at least 1 year, in which a linear negative slope of eGFR of 3 ml/min/1.73 m2/year for males (2.5 ml/min/1.73 m2/year for females) was observed.

Publisher

Oxford University Press (OUP)

Subject

Transplantation,Nephrology

Reference55 articles.

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