■在测试研究的磨合阶段,强化支持治疗后,约半数IgA肾病(IgAN)患者因蛋白尿低于1g/24h而被排除.这些患者的长期预后需要进一步研究。
■112名来自中国10个中心的TESTING研究中筛选失败的患者被纳入这项回顾性研究。88例患者的预后,因蛋白尿低于1克/24小时而被排除在外的人,通过LandmarkKaplan-Meier分析进行了分析。复合肾脏终点定义为eGFR降低≥50%,ESKD(eGFR<15mL/min/1.73m2),慢性透析至少6个月,或肾移植。
■总共,88例患者因蛋白尿小于1g/24h而被排除在外。73/88(83.0%)患者接受肾素-血管紧张素系统阻滞剂。72/88(81.8%)有稳定的蛋白尿缓解,没有接受免疫抑制治疗(IST),16/88(18.2%)因蛋白尿复发而接受IST。LandmarkKaplan-Meier分析表明,在随访的早期阶段,这些排除的IST患者的透析后的肾脏生存率或复合肾脏结局与未接受IST的患者相似(透析,在60个月之前,p=0.778;复合肾脏结局,在48个月前,p=0.862);而接受IST的患者在60个月后的透析风险显着高于未接受IST的患者(OR=11.3,p=0.03)。同样,48个月后接受IST的患者的综合肾脏结局风险也显著高于未接受IST的患者(OR=5.92,p=0.029).
■在强化支持治疗后保持蛋白尿持续缓解的IgAN患者比经历蛋白尿复发并需要IST的患者有更好的长期肾脏结局。
UNASSIGNED: During the run-in phase of the TESTING study, approximately half of patients with IgA nephropathy (IgAN) were excluded due to
proteinuria below 1 g/24 h after intensive supportive therapy. The long-term prognosis of these patients needs further investigation.
UNASSIGNED: 112 screening failed patients in the TESTING study from 10 centers in China were enrolled in this retrospective study. The prognosis of 88 patients, who were excluded because of
proteinuria below 1 g/24 h, was analyzed by Landmark Kaplan-Meier analysis. The composite kidney endpoint was defined by a ≥ 50% reduction in eGFR, ESKD (eGFR <15 mL/min per 1.73 m2), chronic dialysis for at least 6 months, or renal transplantation.
UNASSIGNED: In total, 88 patients were excluded due to
proteinuria less than 1 g/24 h. During the follow-up, 73/88 (83.0%) patients received renin-angiotensin system blocker. 72/88 (81.8%) had stable proteinuria remission and did not receive immunosuppressive therapy (IST), and 16/88 (18.2%) received IST because of a relapse of
proteinuria. Landmark Kaplan-Meier analysis revealed that, the kidney survival from dialysis or composite kidney outcome of these excluded patients with IST was similar to those without IST during the early stages of follow-up (dialysis, before 60 months, p = 0.778; composite kidney outcome, before 48 months, p = 0.862); whereas the risk for dialysis of patients receiving IST was significantly higher than those without IST after 60 months (OR = 11.3, p = 0.03). Similarly, the risk for the composite kidney outcome of patients receiving IST was also significantly higher than those without IST after 48 months (OR = 5.92, p = 0.029).
UNASSIGNED: IgAN patients who maintained a persistent remission of
proteinuria after intensive supportive therapy had a much better long-term kidney outcome than those who experienced a relapse of proteinuria and needed IST.