Spatiotemporal trends and prognosis of end-stage renal disease patients with biopsy-proven immunoglobulin A nephropathy in France from 2010 to 2014

Thomas Robert; Rodolphe Jantzen; Alexandra Cambier; Matthieu Jamme; Cecile Couchoud; Philippe Brunet; Stéphanie Gentile; Eric Rondeau; Laurent Mesnard; Nathanael Lapidus; REIN registry

doi:10.1093/ckj/sfaa029

Spatiotemporal trends and prognosis of end-stage renal disease patients with biopsy-proven immunoglobulin A nephropathy in France from 2010 to 2014

Clin Kidney J. 2020 Mar 16;14(3):898-908. doi: 10.1093/ckj/sfaa029. eCollection 2021 Mar.

Authors

Thomas Robert¹, Rodolphe Jantzen², Alexandra Cambier³, Matthieu Jamme⁴, Cecile Couchoud⁵, Philippe Brunet^{1

5}, Stéphanie Gentile^{1

5}, Eric Rondeau^{4

6}, Laurent Mesnard^{4

6}, Nathanael Lapidus²; REIN registry

Affiliations

¹ Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Marseille, Hôpital de la Conception, Marseille, France.
² Department of Public Health, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, AP-HP, Saint-Antoine Hospital, Paris, France.
³ Pediatric Department of Nephrology and Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital Robert-Debré, Paris, France.
⁴ Department of Intensive Care Nephrology, Transplantation Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université Paris, Paris, France.
⁵ REIN Registry, Agence de la Biomédecine, Saint-Denis la Plaine, France.
⁶ Université Pierre et Marie Curie, INSERM, IMR 1155, Hôpital Tenon, Paris, France.

Abstract

Background: Although end-stage renal disease (ESRD) is frequently used as an outcome marker for primary immunoglobulin A nephropathy (IgAN), the clinical course after reaching ESRD is not well documented. This study examined patients' characteristics and survival in ESRD-related biopsy-proven IgAN in France.

Methods: French Renal Epidemiology and Information Network Registry data from 2010 to 2014 were used to analyse patients' survival and outcome in incident ESRD patients >16 years of age with biopsy-proven primary IgAN, in comparison with other primary and secondary glomerulonephritis (GN), adult polycystic kidney disease (ADPKD) or diabetes. Multivariable survival analysis was adjusted for age, sex, time on dialysis and comorbidities.

Results: Among 17 138 incident dialysis patients with ESRD, IgAN (242.8/10 000 dialysis initiation) represents the most common GN related to ESRD during 2010. IgAN patients were the youngest, and had the fewest comorbidities and the highest use of peritoneal dialysis (PD) (17%). In comparison with the haemodialysis group, hazard ratios for death were not different in the preemptive transplantation group [0.46, 95% confidence interval (CI) 0.17-1.28] and in the PD group (0.77, 95% CI 0.44-1.33). Mortality rates in IgAN patients with preemptive transplantation and in those receiving dialysis waiting for transplantation were 2.9% (95% CI 0.0-5.6) and 6.7% (95% CI 0.9-12.3). Mortality rates of ADPKD patients receiving dialysis waiting for transplantation were higher (18%, 95% CI 3.1-30.6).

Conclusion: IgAN has the best prognosis among primary and secondary GN. IgAN patients receiving dialysis waiting transplantation seem to have a more favourable prognosis than ADPKD patients, who usually comprise the reference population. The underlying reasons for the difference in access treatment modalities should be investigated to improve survival with respect to renal disease.

Keywords: IgA nephropathy end-stage renal disease; clinical epidemiology; dialysis modality; glomerulonephritis; mortality; outcomes.