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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.

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Survival and Survival ROC curves for the Risk Score. (a)Kaplan-Meier outcome-free survival curves by risk score tertiles; (b) the Risk Score’s ROC curves for predicting ESRD at 24 months, 60 months and 120 months.
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pone-0038904-g003: Survival and Survival ROC curves for the Risk Score. (a)Kaplan-Meier outcome-free survival curves by risk score tertiles; (b) the Risk Score’s ROC curves for predicting ESRD at 24 months, 60 months and 120 months.

Mentions: When considered in a stepwise multivariate analysis with all 21 other baseline variables at entry, the risk score was the only independent predictor of adverse renal outcome. It conveyed 2.7-fold increase in the risk of ESRD per one score unit [HR = 2.73, 95%CI: 2.27–3.28] and explained 21.9% of the total variance in the primary outcome. The median ESRD-free survival times for the lowest, middle, and highest tertiles of the Risk Score were 247, 147, and 65 months, respectively. Accordingly, when compared to the first tertile, individuals in the second Risk Score tertile had a 15-fold increase in the risk of ESRD [HR = 15.3, 95%CI: 2.0–115.0)], while individuals in the highest tertile had over 79-fold risk increase [HR = 79.8, 95%CI 11.0–580.3] (Figure 3A and Table S6).


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)

Survival and Survival ROC curves for the Risk Score. (a)Kaplan-Meier outcome-free survival curves by risk score tertiles; (b) the Risk Score’s ROC curves for predicting ESRD at 24 months, 60 months and 120 months.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0038904-g003: Survival and Survival ROC curves for the Risk Score. (a)Kaplan-Meier outcome-free survival curves by risk score tertiles; (b) the Risk Score’s ROC curves for predicting ESRD at 24 months, 60 months and 120 months.
Mentions: When considered in a stepwise multivariate analysis with all 21 other baseline variables at entry, the risk score was the only independent predictor of adverse renal outcome. It conveyed 2.7-fold increase in the risk of ESRD per one score unit [HR = 2.73, 95%CI: 2.27–3.28] and explained 21.9% of the total variance in the primary outcome. The median ESRD-free survival times for the lowest, middle, and highest tertiles of the Risk Score were 247, 147, and 65 months, respectively. Accordingly, when compared to the first tertile, individuals in the second Risk Score tertile had a 15-fold increase in the risk of ESRD [HR = 15.3, 95%CI: 2.0–115.0)], while individuals in the highest tertile had over 79-fold risk increase [HR = 79.8, 95%CI 11.0–580.3] (Figure 3A and Table S6).

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