End-stage kidney disease due to Alport syndrome: outcomes in 296 consecutive Australia and New Zealand Dialysis and Transplant Registry cases.

Abstract

BACKGROUND:

Alport syndrome is a rare inheritable renal disease. Clinical outcomes for patients progressing to end-stage kidney disease (ESKD) are not well described.

METHODS:

This study aimed to investigate the characteristics and clinical outcomes of patients from Australia and New Zealand commencing renal replacement therapy (RRT) for ESKD due to Alport syndrome between 1965 and 1995 (early cohort) and between 1996 and 2010 (contemporary cohort) compared with propensity score-matched, RRT-treated, non-Alport ESKD controls.

RESULTS:

A total of 58 422 patients started RRT during this period of which 296 (0.5%) patients had Alport ESKD. In the early cohort, Alport ESKD was associated with superior dialysis patient survival [adjusted hazard ratio (HR): 0.41, 95% confidence interval (CI): 0.20-0.83, P = 0.01], renal allograft survival (HR: 0.74, 95% CI: 0.54-1.01, P = 0.05) and renal transplant patient survival (HR: 0.43, 95% CI: 0.28-0.66, P < 0.001) compared with controls. In the contemporary cohort, no differences were observed between the two groups for dialysis patient survival (HR: 1.42, 95% CI: 0.65-3.11, P = 0.38), renal allograft survival (HR: 1.01, 95% CI: 0.57-1.79, P = 0.98) or renal transplant patient survival (HR: 0.67, 95% CI: 0.26-1.73, P = 0.41). One Alport patient (0.4%) had post-transplant anti-glomerular basement membrane (anti-GBM) disease. Four female and 41 male Alport patients became parents on RRT with generally good neonatal outcomes.

CONCLUSION:

Alport syndrome patients experienced comparable dialysis and renal transplant outcomes to matched non-Alport ESKD controls in the contemporary cohort due to relatively greater improvements in outcomes for non-Alport ESKD patients over time. Post-transplant anti-GBM disease was rare.

• Authors: Andrew Mallett, Wen Tang, Philip A Clayton, Sarah Stevenson, Stephen P McDonald, Carmel M Hawley, Sunil V Badve, Neil Boudville, Fiona G Brown, Scott B Campbell, David W Johnson
• Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (Nephrol Dial Transplant) Vol. 29 Issue 12 Pg. 2277-86 (Dec 2014) ISSN: 1460-2385 [Electronic] England
• PMID: 25061124 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Australia (epidemiology)
• Child
• Child, Preschool
• Female
• Follow-Up Studies
• Graft Survival
• Humans
• Incidence
• Infant
• Infant, Newborn
• Kidney Failure, Chronic (epidemiology, etiology, surgery)
• Kidney Transplantation
• Male
• Middle Aged
• Nephritis, Hereditary (complications, epidemiology)
• New Zealand (epidemiology)
• Prognosis
• Registries
• Retrospective Studies
• Survival Rate (trends)
• Young Adult