Kidney Week

Abstract: PUB118

Superimposed Focal Segmental Glomerulosclerosis Lesions Worsen Kidney Prognosis in Diabetic Nephropathy (DN)

Session Information

• Publication Only

Category: Diabetic Kidney Disease

• 702 Diabetic Kidney Disease: Clinical

Authors

• Vargas-Brochero, Maria Jose, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Maria Jose Vargas-Brochero, MD, MS, MSc

• Machado, Miriam, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Miriam Machado, MD

• Valencia-Morales, Nancy Daniela, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Nancy Daniela Valencia-Morales, MD

• Casal Moura, Marta Isabel Rodrigues, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Marta Isabel Rodrigues Casal Moura, MD, MS, PhD, MPH

• Abouzahir, Sana, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Sana Abouzahir, MD

• Sethi, Sanjeev, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Sanjeev Sethi, MD, PhD

• Soler, Maria Jose, Hospital Universitari Vall d'Hebron, Barcelona, Catalunya, Spain

Maria Jose Soler, MD, PhD

Background

Patients with biopsy-proven DN may have superimposed focal and segmental glomerulosclerosis(FSGS), and its implications for kidney prognosis have been scarcely assessed. This study aims to assess how the presence of FSGS in patients with DN affects kidney prognosis

Methods

Historical cohort study of biopsy-proven DN from 2010 to 2022. Exclusion criteria included ESKD at diagnosis, primary glomerulopathies, metastatic cancer, pregnancy, transplant of any organ,or lack of follow-up. Primary outcome was comparing the progression to ESKD (defined as an estimated glomerular filtration rate(eGFR)<15 mL/min/1.73m2, kidney transplant, or renal replacement therapy need.Time-to-event analysis was conducted using the Kaplan-Meier (ESKD as the event of interest). Cox proportional hazard regression was used to determine predictive factors associated with ESKD

Results

67 patients; mean age 61.6y, 38(56.7%) male,and 56(83.6%) white. 37 (55.2%) had FSGS lesions. FSGS cohort had a higher presence of non-white ethnicity n=10 (27%)(p=0.009), higher Albumin/creatinine ratio (ACR) (p=0.014), higher IFTA (p=0.009), and percentage of class IV (p=0.037), there were no differences regarding the body mass index.
26 (38.8%) reached ESKD during follow-up; the median follow-up was 3.3 years, and the median survival was 4.13 years. Estimated kidney survival was 86.6 %(78.7-95.1%) at one year, with a significant difference in the FSGS group (long-rank p=0.04).In the multivariate Cox regression model, FSGS (HR, 2.9; 95% CI 1.04 to 8.10), stroke (HR, 5.6; 95% CI 1.8 to 17.7), and albumin (HR, 0.2; 95% CI 0.94 to 0.43), were independently associated with progression to ESKD

Conclusion

Our study characterizes a population with DN and demonstrates how superimposed FSGS is related to a higher risk of progression to ESKD