Comparing Kidney Health Outcomes in Children, Adolescents, and Adults With Focal Segmental Glomerulosclerosis.
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Gipson Debbie S, Troost Jonathan P, Spino Cathie, Attalla Samara, Tarnoff Joshua, Massengill Susan, Lafayette Richard, Vega-Warner Virginia, Adler Sharon, Gipson Patrick, Elliott Matthew, Kaskel Frederick, Fermin Damian, Moxey-Mims Marva, Fine Richard N, Brown Elizabeth J, Reidy Kimberly, Tuttle Katherine, Gibson Keisha, Lemley Kevin V, Greenbaum Larry A, Atkinson Meredith A, Hingorani Sangeeta, Srivastava Tarak, Sethna Christine B, Meyers Kevin, Tran Cheryl, Dell Katherine M, Wang Chia-Shi, Yee Jennifer Lai, Sampson Matthew G, Gbadegesin Rasheed, Lin J J, Brady Tammy, Rheault Michelle, Trachtman Howard
Аннотация
OBJECTIVE: To examine whether there are differences in the kidney health outcomes among children, adolescents, and adults with FSGS.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used pooled and parallel analyses, completed July 5, 2022, from 3 complimentary data sources: (1) Nephrotic Syndrome Rare Disease Clinical Research Network (NEPTUNE); (2) FSGS clinical trial (FSGS-CT); and (3) Kidney Research Network (KRN). NEPTUNE is a multicenter US/Canada cohort study; FSGS-CT is a multicenter US/Canada clinical trial; and KRN is a multicenter US electronic health record-based registry from academic and community nephrology practices. NEPTUNE included 166 patients with incident FSGS enrolled at first kidney biopsy; FSGS-CT included 132 patients with steroid-resistant FSGS randomized to cyclosporine vs dexamethasone with mycophenolate; and KRN included 184 patients with prevalent FSGS. Data were collected from November 2004 to October 2019 and analyzed from October 2020 to July 2022.
EXPOSURES: Age: children (age <13 years) vs adolescents (13-17 years) vs adults (≥18 years). Covariates of interest included sex, disease duration, APOL1 genotype, urine protein-to-creatinine ratio, estimated glomerular filtration rate (eGFR), edema, serum albumin, and immunosuppressive therapy.
MAIN OUTCOMES AND MEASURES: ESKD, composite outcome of ESKD or 40% decline in eGFR, and complete and/or partial remission of proteinuria.
RESULTS: The study included 127 (26%) children, 102 (21%) adolescents, and 253 (52%) adults, including 215 (45%) female participants and 138 (29%) who identified as Black, 98 (20%) who identified as Hispanic, and 275 (57%) who identified as White. Overall, the median time to ESKD was 11.9 years (IQR, 5.2-19.1 years). There was no difference in ESKD risk among children vs adults (hazard ratio [HR], 0.67; 95% CI, 0.43-1.03) or adolescents vs adults (HR, 0.85; 95% CI, 0.52-1.36). The median time to the composite end point was 5.7 years (IQR 1.6-15.2 years), with hazard ratio estimates for children vs adults of 1.12 (95% CI, 0.83-1.52) and adolescents vs adults of 1.06 (95% CI, 0.75-1.50).
CONCLUSIONS AND RELEVANCE: In this study, the association of FSGS with kidney survival and functional outcomes was comparable at all ages.