Kidney Week

Abstract: TH-PO626

Association of Proteinuria Remission and Its Timing with Kidney Outcomes in Patients with Focal Segmental Glomerulosclerosis

Session Information

• Membranous Nephropathy, FSGS, and Minimal Change Disease
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Kawaguchi, Takehiko, National Hospital Organization Chibahigashi National Hospital, Chiba, Japan

Takehiko Kawaguchi, MD, PhD, MPH

• Imasawa, Toshiyuki, National Hospital Organization Chibahigashi National Hospital, Chiba, Japan

Toshiyuki Imasawa, MD, PhD

• Kadomura, Moritoshi, National Hospital Organization Chibahigashi National Hospital, Chiba, Japan

Moritoshi Kadomura, MD

• Kitamura, Hiroshi, National Hospital Organization Chibahigashi National Hospital, Chiba, Japan

Hiroshi Kitamura, MD, PhD

• Ozeki, Takaya, Nagoya University, Nagoya, Japan

Takaya Ozeki, MD, PhD

• Katafuchi, Ritsuko, Ippan Shadan Hojin Nihon Jinzo Gakkai, Bunkyo-ku, Tokyo, Japan

Ritsuko Katafuchi, MD, PhD

• Oka, Kazamasa, Ippan Shadan Hojin Nihon Jinzo Gakkai, Bunkyo-ku, Tokyo, Japan

Kazamasa Oka, MD, PhD

• Furuichi, Kengo, Ippan Shadan Hojin Nihon Jinzo Gakkai, Bunkyo-ku, Tokyo, Japan

Kengo Furuichi, MD, PhD

• Isaka, Yoshitaka, Ippan Shadan Hojin Nihon Jinzo Gakkai, Bunkyo-ku, Tokyo, Japan

Yoshitaka Isaka, MD, PhD

• Sato, Hiroshii, Ippan Shadan Hojin Nihon Jinzo Gakkai, Bunkyo-ku, Tokyo, Japan

Hiroshii Sato, MD, PhD

• Sugiyama, Hitoshi, Ippan Shadan Hojin Nihon Jinzo Gakkai, Bunkyo-ku, Tokyo, Japan

Hitoshi Sugiyama, MD, PhD

• Maruyama, Shoichi, Nagoya University, Nagoya, Japan

Shoichi Maruyama, MD, PhD

Background

Focal Segmental Glomerulosclerosis (FSGS) is a leading cause of end-stage kidney disease (ESKD), and proteinuria remission (PR) is associated with improved renal prognosis in patients with FSGS. However, it is unclear whether the timing of PR affects renal outcome.

Methods

Data on 304 patients with biopsy-confirmed FSGS of Japan Renal Biopsy Registry from 2010 to 2013 were analyzed [median age: 52 years; female: 37%; median eGFR: 58 ml/min/1.73m²; nephrotic proteinuria: 54%; histologic variant: not otherwise specified (NOS) 48%, tip 19%, perihilar 15%, cellular 13%, collapsing 5%]. Patients were divided into 4 groups based on timing of PR (<0.3 g/day) from biopsy: ≦2 months, 2 to 12 months, >12 months, and no PR during follow-up. The primary outcome was a composite of progression to ESKD or all-cause death 5 years after biopsy. Kaplan-Meier curves and multivariable Cox models were used to compare the outcomes among these groups.

Results

One hundred thirty-six patients (45%) achieved PR, with a median time to PR of 4 (interquartile range 2, 13) months (Figure 1). During the median follow-up period of 4.8 years, outcome events occurred in 37 patients (12%). Overall, PR was associated with the primary outcome (adjusted hazard ratio [aHR]: 0.08 [95% confidence interval (CI), 0.02-0.30]). However, no significant difference in the outcome was found among the three groups achieving PR (Figure 2); compared with PR ≦2 months, the aHR for the outcome was 0.87 [95% CI, 0.05-14.2] for PR between 2 and 12 months, 1.04 [95% CI, 0.06-17.6] for PR ≧12 months, and 11.1 [95% CI, 1.38-93.5] for no PR.

Conclusion

Although PR itself has an impact on renal outcomes of FSGS during 5 years, the timing of PR may not predict improved renal prognosis. Specific strategies and interventions to achieve PR should be implemented for better renal outcomes at any clinical stage of FSGS.

Funding

• Government Support – Non-U.S.