Time-Varying Proteinuria and Progression of IgA Nephropathy: A Cohort Study
Abstract
RATIONALE & OBJECTIVE
Proteinuria is a surrogate endpoint for predicting long-term kidney outcomes in IgA nephropathy (IgAN) with levels <1 g/d identified as a therapeutic target. However, this threshold has not been sufficiently studied. We aimed to quantify the associations of progression of IgAN with various levels of proteinuria.
STUDY DESIGN
Observational cohort study.
SETTING
& Participants: 1530 patients with IgAN and at least 12 months of follow-up at Peking University First Hospital.
EXPOSURE
Proteinuria levels updated over time (TV-P).
OUTCOMES
A composite kidney outcome of a 50% reduction in the eGFR or end-stage kidney disease (ESKD).
ANALYTICAL APPROACH
Marginal structural models (MSMs).
RESULTS
After a median follow-up of 43.5 [27.2, 72.8] months, 254 (16.6%) patients developed the composite kidney outcome. A graded association was observed between TV-P and composite kidney outcomes with higher risk among those with proteinuria ≥0.5 g/d. Compared with TV-P <0.3 g/d, the HRs (95% CI) for proteinuria levels of 0.3 - <0.5 g/d, 0.5 - <1.0 g/d, 1.0 - <2.0 g/d and ≥ 2.0 g/d were 2.22 (0.88-5.58), 4.04 (1.93-8.46), 8.46 (3.80-18.83) and 38.00 (17.62-81.95), respectively. The trend was more pronounced in patients with baseline proteinuria ≥1.0 g/d among whom a higher risk was observed with TV-P of 0.3 to <0.5 g/d compared to TV-P < 0.3 g/d (HR 3.26, 95% CI 1.07-9.92; P=0.04). However, in patients with baseline proteinuria levels <1 g/d, the risk of composite kidney…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 1,530 participants or records.
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