Time-averaged albumin predicts the long-term prognosis of IgA nephropathy patients who achieved remission
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RESEARCH
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Time-averaged albumin predicts the long-term prognosis of IgA nephropathy patients who achieved remission Zhaohui Ni†, Yanhong Yuan†, Qin Wang, Liou Cao, Xiajing Che, Minfang Zhang, Yuanyuan Xie, Chaojun Qi and Shan Mou*
Abstract Background: Primary IgA nephropathy (IgAN) is the most common form of idiopathic glomerulonephritis worldwide. Although most patients are able to achieve remission with the current therapy, a large number of patients will still progress to end-stage renal disease. This study aimed to evaluate kidney disease progression and the risk factors for progression in IgAN patients who achieved remission. Methods: Patients from a prospective database with IgAN were included in this study. All the subjects had achieved a complete remission (CR) or partial remission (PR) following 6 months of therapy. Renal survival and the relationship between the clinical parameters and composite renal outcomes were assessed. Results: The study comprised 878 IgAN patients recruited between January 2005 and December 2010. Overall, 632 patients were enrolled in this study. The data from the 369 patients who achieved remission were analyzed; the mean follow-up time was 49 months. The median serum creatinine (SCr) concentration at baseline was 91.3 μmol/L, and the time-averaged creatinine (TA-SCr) was 91.8 μmol/L. The mean serum albumin (ALB) level at baseline was 39.4 g/L, and the time-averaged serum albumin (TA-ALB) was 42.1 g/L. Multivariate Cox regression analyses revealed that the TA-ALB and TA-SCr levels were independently associated with the composite renal outcome. The patients with a TA-SCr value > 120 μmol/L and a TA-ALB level < 38 g/L were less likely to recover from renal progression. Conclusion: The strong predictive relationship of low TA-ALB and high TA-SCr levels with progression observed in this study suggests that TA-ALB may serve as a marker of the long-term renal prognosis of IgAN patients who have achieved remission. Keywords: IgA nephropathy, Remission, Renal progression, Risk factor, Time-averaged serum albumin
Introduction Primary IgA nephropathy (IgAN) is a very common idiopathic glomerulonephritis (GN) throughout the world [1], especially in China, where IgAN accounts for 58.2% of the GN cases [2]. Studies have confirmed that 1%-2% of IgAN patients will develop end stage renal disease (ESRD) within 1 year of diagnosis [3,4], and approximately 40% of patients will ultimately develop ESRD within 20 years [5,6]. A wide variety of treatments have * Correspondence: [email protected] † Equal contributors Department of Nephrology, Molecular Cell Lab for Kidney Disease, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai 200127, China
been attempted to slow the progression of IgAN. Based on the evidence, most treatment guidelines for IgAN recommend optimal blood pressure control and suggest adding steroids for those patients with persistent proteinuria, regardless of supportive therapy [7]. However, few studies have evaluated th
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