ESRD: membranous nephropathy etiology tied to better outcomes

  • Yang WL & al.
  • PLoS One
  • 23 Aug 2019

  • International Clinical Digest
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Takeaway

  • End-stage renal disease (ESRD) secondary to membranous nephropathy (MN) is associated with superior survival with dialysis or kidney transplant (KT) compared with ESRD with other etiologies.

Why this matters

  • Compared with other forms of glomerulonephritis (GN), MN was tied to greater death-censored graft loss driven by primary disease recurrence.

Study design

  • Registry-based study of 32,788 patients initiating renal replacement therapy in Australia and New Zealand during 1998-2010; 1.27% had MN.
  • Funding: None.

Key results

  • Among patients on dialysis, adjusted survival rates were higher with MN vs other etiologies at 1 (98% vs 93%), 5 (81% vs 65%) and 10 years (58% vs 36%).
  • MN was associated with:
    • 21% lower mortality risk on dialysis vs other ESRD (aHR=0.79; P=.002);
    • 43% lower mortality risk after KT vs other ESRD (aHR=0.57; P=.04); and
    • Similar survival vs other forms of GN (P=.42; P=.11).
  • Among dialysis-treated patients, MN was tied to a greater likelihood of KT than other ESRD etiologies (subhazard [S]HR=1.48; P<.001 or forms of gn>
  • MN was tied to greater post-KT primary recurrence than other ESRD etiologies (aHR=4.92; P<.001 and forms of gn>
  • In competing-risk analysis, death-censored graft loss was higher with MN than other types of ESRD (SHR=1.59; P=.02) and GN (SHR=1.63; P=.02).

Limitations

  • Retrospective design.