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Abstract：
UNASSIGNED: The importance of albuminuria as opposed to proteinuria in predicting kidney outcomes in primary immunoglobulin A nephropathy (IgAN) is not well established.
UNASSIGNED: From 2010 to 2012, 421 patients with biopsy-proven IgAN have been enrolled into the German Chronic Kidney Disease (GCKD) cohort, a prospective observational cohort study (N = 5217). Adjudicated endpoints include a composite kidney endpoint (CKE) consisting of eGFR decline >40%, eGFR <15 ml/min/1.73 m2 and initiation of kidney replacement therapy; the individual components of the CKE; and combined major adverse cardiac events (MACE), including non-fatal myocardial infarction, non-fatal stroke and all-cause mortality. The associations between the incidence of CKE and baseline factors, including demographics, laboratory values and comorbidities were analysed using the Cox proportional hazards regression model.
UNASSIGNED: The mean age of IgAN patients at baseline was 51.6 years (± 13.6) and 67% were male. The patient-reported duration of disease at baseline was 5.9 ± 8.1 years. Baseline median urine albumin:creatinine ratio (UACR) was 0.4 g/g [interquartile range (IQR) 0.1-0.8] and mean eGFR was 52.5 ± 22.4 ml/min/1.73 m2. Over a follow-up of 6.5 years, 64 (15.2%) patients experienced a >40% eGFR decline, 3 (0.7%) reached eGFR <15 ml/min/1.73 m2, 53 (12.6%) initiated kidney replacement therapy and 28% of the patients experienced the CKE. Albuminuria, with reference to <0.1 g/g, was most associated with CKE. Hazard ratios (HRs) at UACRs of 0.1-0.6 g/g, 0.6-1.4 g/g, 1.4-2.2 g/g and >2.2 g/g were 2.03 [95% confidence interval (CI) 1.02-4.05], 3.8 (95% CI 1.92-7.5), 5.64 (95% CI 2.58-12.33) and 5.02 (95% CI 2.29-11-03), respectively. Regarding MACE, the presence of diabetes [HR 2.53 (95% CI 1.11-5.78)] was the most strongly associated factor, whereas UACR and eGFR did not show significant associations.
UNASSIGNED: In the GCKD IgAN subcohort, more than every fourth patient experienced a CKE event within 6.5 years. Our findings support the use of albuminuria as a surrogate to assess the risk of poor kidney outcomes.
UNASSIGNED: From 2010 to 2012, 421 patients with biopsy-proven IgAN have been enrolled into the German Chronic Kidney Disease (GCKD) cohort, a prospective observational cohort study (N = 5217). Adjudicated endpoints include a composite kidney endpoint (CKE) consisting of eGFR decline >40%, eGFR <15 ml/min/1.73 m2 and initiation of kidney replacement therapy; the individual components of the CKE; and combined major adverse cardiac events (MACE), including non-fatal myocardial infarction, non-fatal stroke and all-cause mortality. The associations between the incidence of CKE and baseline factors, including demographics, laboratory values and comorbidities were analysed using the Cox proportional hazards regression model.
UNASSIGNED: The mean age of IgAN patients at baseline was 51.6 years (± 13.6) and 67% were male. The patient-reported duration of disease at baseline was 5.9 ± 8.1 years. Baseline median urine albumin:creatinine ratio (UACR) was 0.4 g/g [interquartile range (IQR) 0.1-0.8] and mean eGFR was 52.5 ± 22.4 ml/min/1.73 m2. Over a follow-up of 6.5 years, 64 (15.2%) patients experienced a >40% eGFR decline, 3 (0.7%) reached eGFR <15 ml/min/1.73 m2, 53 (12.6%) initiated kidney replacement therapy and 28% of the patients experienced the CKE. Albuminuria, with reference to <0.1 g/g, was most associated with CKE. Hazard ratios (HRs) at UACRs of 0.1-0.6 g/g, 0.6-1.4 g/g, 1.4-2.2 g/g and >2.2 g/g were 2.03 [95% confidence interval (CI) 1.02-4.05], 3.8 (95% CI 1.92-7.5), 5.64 (95% CI 2.58-12.33) and 5.02 (95% CI 2.29-11-03), respectively. Regarding MACE, the presence of diabetes [HR 2.53 (95% CI 1.11-5.78)] was the most strongly associated factor, whereas UACR and eGFR did not show significant associations.
UNASSIGNED: In the GCKD IgAN subcohort, more than every fourth patient experienced a CKE event within 6.5 years. Our findings support the use of albuminuria as a surrogate to assess the risk of poor kidney outcomes.
摘要：
■与蛋白尿相比，蛋白尿在预测原发性免疫球蛋白A肾病（IgAN）的肾脏结局中的重要性尚未得到很好的证实。
■从2010年到2012年，421例经活检证实的IgAN患者已被纳入德国慢性肾脏病（GCKD）队列，前瞻性观察性队列研究（N=5217）。裁定的终点包括由eGFR下降>40％组成的复合肾脏终点（CKE），eGFR<15ml/min/1.73m2并开始肾脏替代疗法；CKE的各个组成部分；以及合并的主要不良心脏事件（MACE），包括非致命性心肌梗死,非致命性卒中和全因死亡率。CKE发生率与基线因素之间的关联，包括人口统计，使用Cox比例风险回归模型分析实验室值和合并症.
■IgAN患者基线时的平均年龄为51.6岁(±13.6)，67%为男性。患者报告的基线疾病持续时间为5.9±8.1年。基线中位数尿白蛋白：肌酐比率（UACR）为0.4g/g[四分位距（IQR）0.1-0.8]，平均eGFR为52.5±22.4ml/min/1.73m2。在6.5年的随访中，64例(15.2%)患者eGFR下降>40%，3（0.7％）达到eGFR<15ml/min/1.73m2，53（12.6％）开始肾脏替代疗法，28％的患者经历了CKE。白蛋白尿,参考<0.1g/g，与CKE密切相关。UACR为0.1-0.6g/g时的危险比(HR)，0.6-1.4g/g，1.4-2.2g/g和>2.2g/g分别为2.03[95％置信区间（CI）1.02-4.05]，3.8（95%CI1.92-7.5），5.64（95%CI2.58-12.33）和5.02（95%CI2.29-11-03），分别。关于MACE,糖尿病的存在[HR2.53（95％CI1.11-5.78）]是最强烈的相关因素，而UACR和eGFR未显示显著关联.
■在GCKDIgAN子队列中，超过四分之一的患者在6.5年内经历了CKE事件.我们的研究结果支持使用白蛋白尿作为替代来评估不良肾脏预后的风险。
■从2010年到2012年，421例经活检证实的IgAN患者已被纳入德国慢性肾脏病（GCKD）队列，前瞻性观察性队列研究（N=5217）。裁定的终点包括由eGFR下降>40％组成的复合肾脏终点（CKE），eGFR<15ml/min/1.73m2并开始肾脏替代疗法；CKE的各个组成部分；以及合并的主要不良心脏事件（MACE），包括非致命性心肌梗死,非致命性卒中和全因死亡率。CKE发生率与基线因素之间的关联，包括人口统计，使用Cox比例风险回归模型分析实验室值和合并症.
■IgAN患者基线时的平均年龄为51.6岁(±13.6)，67%为男性。患者报告的基线疾病持续时间为5.9±8.1年。基线中位数尿白蛋白：肌酐比率（UACR）为0.4g/g[四分位距（IQR）0.1-0.8]，平均eGFR为52.5±22.4ml/min/1.73m2。在6.5年的随访中，64例(15.2%)患者eGFR下降>40%，3（0.7％）达到eGFR<15ml/min/1.73m2，53（12.6％）开始肾脏替代疗法，28％的患者经历了CKE。白蛋白尿,参考<0.1g/g，与CKE密切相关。UACR为0.1-0.6g/g时的危险比(HR)，0.6-1.4g/g，1.4-2.2g/g和>2.2g/g分别为2.03[95％置信区间（CI）1.02-4.05]，3.8（95%CI1.92-7.5），5.64（95%CI2.58-12.33）和5.02（95%CI2.29-11-03），分别。关于MACE,糖尿病的存在[HR2.53（95％CI1.11-5.78）]是最强烈的相关因素，而UACR和eGFR未显示显著关联.
■在GCKDIgAN子队列中，超过四分之一的患者在6.5年内经历了CKE事件.我们的研究结果支持使用白蛋白尿作为替代来评估不良肾脏预后的风险。
