Long-term outcomes of end-stage kidney disease for patients with IgA nephropathy: A multi-centre registry study.
BACKGROUND
Clinical outcomes of patients with end-stage kidney disease (ESKD) receiving renal replacement therapy (RRT) secondary to IgA nephropathy (IgAN) have not been well described.


AIM
To investigate the characteristics, treatments and outcomes of ESKD because of kidney-limited IgAN and Henoch-Schönlein purpura nephritis (HSPN) in the Australian and New Zealand RRT populations.


METHODS
All ESKD patients who commenced RRT in Australia and New Zealand between 1971 and 2012 were included. Dialysis and transplant outcomes were evaluated in both a contemporary cohort (1998-2012) and the entire cohort (1971-2012).


RESULTS
Of 63 297 ESKD patients, 3721 had kidney-limited IgAN, and 131 had HSPN. For the contemporary cohort of IgAN patients on dialysis (n = 2194), 10-year patient survival was 65%. Of 1368 contemporary IgAN patients who received their first renal allograft, 10-year patient, overall renal allograft and death-censored renal allograft survival were 93%, 82% and 88%, respectively. Using multivariable Cox regression analysis, patients with IgAN had favourable dialysis patient survival (adjusted hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.57-0.69), overall renal allograft survival (HR 0.67, 95% CI 0.57-0.79) and renal transplant patient survival (HR 0.58, 95% CI 0.45-0.74) compared with ESKD controls. Similar results were found in the entire cohort and when using competing-risks models. Compared with kidney-limited IgAN patients, those with HSPN had worse dialysis patient survival (HR 1.94, 95% CI 1.02-3.69), overall renal allograft survival (HR 3.40, 95% CI 1.00-11.55) and renal transplant patient survival (HR 3.50, 95% CI 1.03-11.92).


CONCLUSION
IgAN ESKD was associated with better dialysis and renal transplant outcomes compared with other forms of ESKD. The survival outcomes of ESKD patients with HSPN were worse than kidney-limited IgAN.
['Zhang|Lei|L|', 'Liu|Xusheng|X|', 'Pascoe|Elaine M|EM|', 'Badve|Sunil V|SV|', 'Boudville|Neil C|NC|', 'Clayton|Philip A|PA|', 'De Zoysa|Janak|J|', 'Hawley|Carmel M|CM|', 'Kanellis|John|J|', 'McDonald|Stephen P|SP|', 'Peh|Chen Au|CA|', 'Polkinghorne|Kevan R|KR|', 'Johnson|David W|DW|']
D001315:Australia D016009:Chi-Square Distribution D018450:Disease Progression D005922:Glomerulonephritis, IGA D006085:Graft Survival D006801:Humans D011695:IgA Vasculitis D015994:Incidence D053208:Kaplan-Meier Estimate D007676:Kidney Failure, Chronic D016030:Kidney Transplantation D015999:Multivariate Analysis D009520:New Zealand D016016:Proportional Hazards Models D012042:Registries D006435:Renal Dialysis D018570:Risk Assessment D012307:Risk Factors D013997:Time Factors D016896:Treatment Outcome
outcomes end-stage kidney disease IgA nephropathy Henoch-Schönlein purpura dialysis renal transplantation