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Nitta Kosaku
Department Other, Other Position |
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| Article types | Original article |
| Language | English |
| Peer review | Non peer reviewed |
| Title | Biopsy-proven CKD etiology and outcomes: the Chronic Kidney Disease Japan Cohort (CKD-JAC) study. |
| Journal | Formal name：Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association Abbreviation：Nephrol Dial Transplant ISSN code：14602385/09310509 |
| Volume, Issue, Page | 38(2),pp.384-395 |
| Author and coauthor | Hamano Takayuki, Imaizumi Takahiro, Hasegawa Takeshi, Fujii Naohiko, Komaba Hirotaka, Ando Masahiko, Nangaku Masaomi, Nitta Kosaku, Hirakata Hideki, Isaka Yoshitaka, Wada Takashi, Maruyama Shoichi, Fukagawa Masafumi |
| Publication date | 2023/02/13 |
| Summary | BACKGROUND:The Kidney Disease: Improving Global Outcomes guidelines advocate the cause-glomerular filtration rate (GFR)-albuminuria (CGA) classification for predicting outcomes. However, there is a dearth of data supporting the use of the cause of chronic kidney disease. This study aimed to address how to incorporate a prior biopsy-proven diagnosis in outcome prediction.METHODS:We examined the association of biopsy-proven kidney disease diagnoses with kidney failure with replacement therapy (KFRT) and all-cause death before KFRT in patients with various biopsy-proven diagnoses (n = 778, analysis A) and patients with diabetes mellitus labeled with biopsy-proven diabetic nephropathy (DN), other biopsy-proven diseases and no biopsy (n = 1117, analysis B).RESULTS:In analysis A, adding biopsy-proven diagnoses to the GFR-albuminuria (GA) classification improved the prediction of 8-year incidence of KFRT and all-cause death significantly regarding integrated discrimination improvement and net reclassification index. Fine-Gray (FG) models with KFRT as a competing event showed significantly higher subdistribution hazard ratios (SHRs) for all-cause death in nephrosclerosis {4.12 [95% confidence interval (CI) 1.11-15.2)], focal segmental glomerulosclerosis [3.77 (95% CI 1.09-13.1)]} and membranous nephropathy (MN) [2.91 (95% CI 1.02-8.30)] than in immunoglobulin A nephropathy (IgAN), while the Cox model failed to show significant associations. Crescentic glomerulonephritis had the highest risk of all-cause death [SHR 5.90 (95% CI 2.05-17.0)]. MN had a significantly lower risk of KFRT than IgAN [SHR 0.45 (95% CI 0.24-0.84)]. In analysis B, other biopsy-proven diseases had a lower risk of KFRT than biopsy-proven DN in the FG model, with death as a competing event [SHR 0.62 (95% CI 0.39-0.97)].CONCLUSIONS:The CGA classification is of greater value in predicting outcomes than the GA classification. |
| DOI | 10.1093/ndt/gfac134 |
| PMID | 35323977 |