Limits...
Predicting progression of IgA nephropathy: new clinical progression risk score.

Xie J, Kiryluk K, Wang W, Wang Z, Guo S, Shen P, Ren H, Pan X, Chen X, Zhang W, Li X, Shi H, Li Y, Gharavi AG, Chen N - PLoS ONE (2012)

Bottom Line: In the fully adjusted Cox proportional hazards model, there were four baseline variables with a significant independent effect on the risk of ESRD.Survival ROC curves revealed that the risk score provided improved prediction of ESRD at 24th, 60th and 120th month of follow-up compared to the three previously proposed risk scores.The new progression risk score calculated based on these four baseline variables offers a simple clinical tool for risk stratification.

View Article: PubMed Central - PubMed

Affiliation: Nephrology Department, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

ABSTRACT
IgA nephropathy (IgAN) is a common cause of end-stage renal disease (ESRD) in Asia. In this study, based on a large cohort of Chinese patients with IgAN, we aim to identify independent predictive factors associated with disease progression to ESRD. We collected retrospective clinical data and renal outcomes on 619 biopsy-diagnosed IgAN patients with a mean follow-up time of 41.3 months. In total, 67 individuals reached the study endpoint defined by occurrence of ESRD necessitating renal replacement therapy. In the fully adjusted Cox proportional hazards model, there were four baseline variables with a significant independent effect on the risk of ESRD. These included: eGFR [HR = 0.96(0.95-0.97)], serum albumin [HR = 0.47(0.32-0.68)], hemoglobin [HR = 0.79(0.72-0.88)], and SBP [HR = 1.02(1.00-1.03)]. Based on these observations, we developed a 4-variable equation of a clinical risk score for disease progression. Our risk score explained nearly 22% of the total variance in the primary outcome. Survival ROC curves revealed that the risk score provided improved prediction of ESRD at 24th, 60th and 120th month of follow-up compared to the three previously proposed risk scores. In summary, our data indicate that IgAN patients with higher systolic blood pressure, lower eGFR, hemoglobin, and albumin levels at baseline are at a greatest risk of progression to ESRD. The new progression risk score calculated based on these four baseline variables offers a simple clinical tool for risk stratification.

Show MeSH

Related in: MedlinePlus

Kaplan-Meier Outcome-free Survival Curves.(a) low (red) versus high (black) baseline eGFR group; (b) patients with a baseline diagnosis of anemia (red) versus no anemia (black); (c) patients with hypoalbuminemia (red) versus normoalbuminemia (black); (d) patients with systolic hypertension (red) versus normotensives (black). Censor points are denoted by vertical tick lines.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3375310&req=5

pone-0038904-g001: Kaplan-Meier Outcome-free Survival Curves.(a) low (red) versus high (black) baseline eGFR group; (b) patients with a baseline diagnosis of anemia (red) versus no anemia (black); (c) patients with hypoalbuminemia (red) versus normoalbuminemia (black); (d) patients with systolic hypertension (red) versus normotensives (black). Censor points are denoted by vertical tick lines.

Mentions: As expected, eGFR at presentation was the strongest predictor of ESRD: each unit decrease in baseline eGFR was associated with 4% increase in the risk of ESRD during the follow-up period. Accordingly, individuals with baseline eGFR >60 ml/min/1.73 m2 had considerably longer median outcome-free survival time when compared to those with eGFR <60 ml/min/1.73 m2 (242 months versus 72 months) [HR = 7.91, 95%CI: 4.60–13.60, Figure 1A].


Predicting progression of IgA nephropathy: new clinical progression risk score.

Xie J, Kiryluk K, Wang W, Wang Z, Guo S, Shen P, Ren H, Pan X, Chen X, Zhang W, Li X, Shi H, Li Y, Gharavi AG, Chen N - PLoS ONE (2012)

Kaplan-Meier Outcome-free Survival Curves.(a) low (red) versus high (black) baseline eGFR group; (b) patients with a baseline diagnosis of anemia (red) versus no anemia (black); (c) patients with hypoalbuminemia (red) versus normoalbuminemia (black); (d) patients with systolic hypertension (red) versus normotensives (black). Censor points are denoted by vertical tick lines.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3375310&req=5

pone-0038904-g001: Kaplan-Meier Outcome-free Survival Curves.(a) low (red) versus high (black) baseline eGFR group; (b) patients with a baseline diagnosis of anemia (red) versus no anemia (black); (c) patients with hypoalbuminemia (red) versus normoalbuminemia (black); (d) patients with systolic hypertension (red) versus normotensives (black). Censor points are denoted by vertical tick lines.
Mentions: As expected, eGFR at presentation was the strongest predictor of ESRD: each unit decrease in baseline eGFR was associated with 4% increase in the risk of ESRD during the follow-up period. Accordingly, individuals with baseline eGFR >60 ml/min/1.73 m2 had considerably longer median outcome-free survival time when compared to those with eGFR <60 ml/min/1.73 m2 (242 months versus 72 months) [HR = 7.91, 95%CI: 4.60–13.60, Figure 1A].

Bottom Line: In the fully adjusted Cox proportional hazards model, there were four baseline variables with a significant independent effect on the risk of ESRD.Survival ROC curves revealed that the risk score provided improved prediction of ESRD at 24th, 60th and 120th month of follow-up compared to the three previously proposed risk scores.The new progression risk score calculated based on these four baseline variables offers a simple clinical tool for risk stratification.

View Article: PubMed Central - PubMed

Affiliation: Nephrology Department, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

ABSTRACT
IgA nephropathy (IgAN) is a common cause of end-stage renal disease (ESRD) in Asia. In this study, based on a large cohort of Chinese patients with IgAN, we aim to identify independent predictive factors associated with disease progression to ESRD. We collected retrospective clinical data and renal outcomes on 619 biopsy-diagnosed IgAN patients with a mean follow-up time of 41.3 months. In total, 67 individuals reached the study endpoint defined by occurrence of ESRD necessitating renal replacement therapy. In the fully adjusted Cox proportional hazards model, there were four baseline variables with a significant independent effect on the risk of ESRD. These included: eGFR [HR = 0.96(0.95-0.97)], serum albumin [HR = 0.47(0.32-0.68)], hemoglobin [HR = 0.79(0.72-0.88)], and SBP [HR = 1.02(1.00-1.03)]. Based on these observations, we developed a 4-variable equation of a clinical risk score for disease progression. Our risk score explained nearly 22% of the total variance in the primary outcome. Survival ROC curves revealed that the risk score provided improved prediction of ESRD at 24th, 60th and 120th month of follow-up compared to the three previously proposed risk scores. In summary, our data indicate that IgAN patients with higher systolic blood pressure, lower eGFR, hemoglobin, and albumin levels at baseline are at a greatest risk of progression to ESRD. The new progression risk score calculated based on these four baseline variables offers a simple clinical tool for risk stratification.

Show MeSH
Related in: MedlinePlus