A national registry study of patient and renal survival in adult nephrotic syndrome

Kolb, A. et al. (2021) A national registry study of patient and renal survival in adult nephrotic syndrome. Kidney International Reports, 6(2), pp. 449-459. (doi: 10.1016/j.ekir.2020.10.033) (PMID:33615070) (PMCID:PMC7879209)

Abstract

Introduction: We aimed to determine the mortality rate, cause of death, and rate of end-stage kidney disease (ESKD) in adults with nephrotic syndrome (NS). Methods: We conducted a national registry–based study, including all 522 adults who had a kidney biopsy for NS in Scotland in 2014–2017. We linked the Scottish Renal Registry to death certificate data. We performed survival and Cox proportional hazards analyses, accounting for competing risks of death and ESKD. We compared mortality rates with those in the age- and sex-matched general population. Results: A total of 372 patients had primary NS; 150 had secondary NS. Over a median follow-up of 866 days, 110 patients (21%) died. In patients with primary NS, observed versus population 3-year mortality was 2.1% (95% CI 0.0%–4.6%) versus 0.9% (0.8%–1.0%) in patients aged <60 years and 24.9% (18.4%–30.8%) versus 9.4% (8.3%–10.5%) in those aged ≥60 years. In secondary NS, this discrepancy was 17.1% (5.6%–27.2%) versus 1.1% (0.9%–1.2%) in <60-year-olds and 49.4% (36.6%–59.7%) versus 8.1% (6.6%–9.6%) in ≥60-year-olds. In primary NS, cardiovascular causes accounted for 28% of deaths, compared with 18% in the general population. Eighty patients (15%) progressed to ESKD. Incidence of ESKD by 3 years was 8.4% (95% CI 4.9%–11.7%) in primary and 35.1% (24.3%–44.5%) in secondary NS. Early remission of proteinuria and the absence of early acute kidney injury (AKI) were associated with lower rates of death and ESKD. Conclusions: Adults with NS have high rates of death and ESKD. Cardiovascular causes account for excess mortality in primary NS.

• Item Type: Articles
• Additional Information: RWH is supported by a Fellowship from the Wellcome Trust (209562/Z/17/Z).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McQuarrie, Dr Emily and Dey, Dr Vishal and Traynor, Dr Jamie and Geddes, Dr Colin
• Authors: Kolb, A., Gallacher, P. J., Campbell, J., O’Neill, M., Smith, J. R., Bell, S., Conway, B. R., Metcalfe, W., Joss, N., Dey, V., Alfonzo, A., Kelly, M., Shah, S., McQuarrie, E., Geddes, C., Traynor, J., and Hunter, R. W.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Kidney International Reports
• Publisher: Elsevier
• ISSN: 2468-0249
• ISSN (Online): 2468-0249
• Published Online: 04 November 2020
• Copyright Holders: Copyright © 2020 International Society of Nephrology
• First Published: First published in Kidney International Reports 6(2): 449-459
• Publisher Policy: Reproduced under a Creative Commons License