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The prognostic effect of immunosuppressive therapy in IgA nephropathy with stage 3 or 4 chronic kidney disease.

Authors :
Yang, Xiaoxia
Ma, Feng
Bai, Ming
Wang, Yan
Jia, Qing
Dong, Ruijuan
Liu, Chunmei
Sun, Shiren
Source :
Renal Failure; Dec 2021, Vol. 43 Issue 1, p1180-1187, 8p
Publication Year :
2021

Abstract

It is debated whether patients with IgAN with heavy proteinuria and decreased eGFR benefit from aggressive treatment consisting of corticosteroids alone or combined with immunosuppressive agents. A retrospective study was performed between January 2008 and December 2016 on patients with IgAN who had urinary protein excretion > 1.0 g/d and an eGFR between 15 and 59 mL/min/1.73 m<superscript>2</superscript>. These patients were assigned to receive supportive care alone or supportive care plus immunosuppressive therapy. The primary outcome was defined as the first occurrence of a 50% decrease in eGFR or the development of ESKD. All 208 included patients were followed for a median of 43 months, and 92 (44%) patients experienced the primary outcome. Cumulative kidney survival was better in the immunosuppression group than in the supportive care group (p <.001). The median annual rate of eGFR decline in the immunosuppression group was −2.0 (−7.3 to 4.2), compared with −8.4 (–18.9 to −4.1) mL/min/1.73 m<superscript>2</superscript> in the supportive care group (p <.001). In multivariate Cox regression analyses, immunosuppressive therapy was associated with a lower risk of progression to ESKD, independent of age, sex, eGFR, proteinuria, MAP, kidney histologic findings and the use of RASi agents (HR = 0.335; 95% CI 0.209–0.601). Among the adverse events, infection requiring hospitalization occurred at similar rates in both groups (p =.471). Immunosuppressive therapy attenuated the rate of eGFR decline and was associated with a favorable kidney outcome in IgAN patients with heavy proteinuria and decreased eGFR, and the side effects were tolerable. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
0886022X
Volume :
43
Issue :
1
Database :
Complementary Index
Journal :
Renal Failure
Publication Type :
Academic Journal
Accession number :
154864556
Full Text :
https://doi.org/10.1080/0886022X.2021.1956536