Abstract | BACKGROUND AND OBJECTIVES:
Proteinuria is used as an indicator of FSGS disease activity, but its use as a clinical trial end point is not universally accepted. The goal of this study was to refine proteinuria definitions associated with long-term kidney survival. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Data on 466 patients with primary FSGS with proteinuria (urine protein-to- creatinine ratio >1 g/g) were analyzed from five independent cohorts. Proteinuria by months 1, 4, and 8 after study baseline was categorized by conventional definitions of complete (<0.3 g/g) and partial remission (<3.5 g/g and 50% reduction in proteinuria). Novel remission definitions were explored using receiver operating curves. Kaplan-Meier methods were used to estimate the associations of proteinuria with progression to ESRD or a 50% loss in kidney function. Propensity score-adjusted Cox proportional hazards models were used to adjust for baseline proteinuria, eGFR, and therapy. RESULTS: In the initial derivation cohort, conventional partial remission was not associated with kidney survival. A novel definition of partial remission (40% proteinuria reduction and proteinuria<1.5 g/g) on the basis of receiver operating curve analyses of 89 patients was identified (Sensitivity=0.70; Specificity=0.77). In the validation cohort analyses, complete remission was associated with better prognosis (6 out of 41 patients progressed to kidney failure; 6.6 per 100 patient-years) as was the novel partial remission (13 out of 71 progressed; 8.5 per 100 patient-years), compared with those with no response (51 out of 116 progressed; 20.1 per 100 patient-years). Conventional partial remission at month 8, but not month 4, was also associated with better response (19 out of 85 patients progressed; risk=10.4 per 100 patient-years). Propensity score-adjusted analyses showed the novel partial remission was associated with less progression at months 4 and 8 (month 4: hazard ratio, 0.50; P=0.01; month 8: hazard ratio, 0.30; P=0.002). CONCLUSIONS: Reaching either a complete or partial remission using a novel or conventional definition was associated with better long-term outcomes in patients with FSGS. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_02_20_CJASNPodcast_18_3_T.mp3.
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Authors | Jonathan P Troost, Howard Trachtman, Patrick H Nachman, Matthias Kretzler, Cathie Spino, Radko Komers, Sarah Tuller, Kalyani Perumal, Susan F Massengill, Elaine S Kamil, Gia Oh, David T Selewski, Patrick Gipson, Debbie S Gipson |
Journal | Clinical journal of the American Society of Nephrology : CJASN
(Clin J Am Soc Nephrol)
Vol. 13
Issue 3
Pg. 414-421
(03 07 2018)
ISSN: 1555-905X [Electronic] United States |
PMID | 29167190
(Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Validation Study)
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Copyright | Copyright © 2018 by the American Society of Nephrology. |
Chemical References |
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Topics |
- Adolescent
- Adult
- Biomarkers
(urine)
- Child
- Creatinine
(urine)
- Disease Progression
- Endpoint Determination
- Female
- Glomerular Filtration Rate
- Glomerulosclerosis, Focal Segmental
(complications, drug therapy, physiopathology, urine)
- Humans
- Kaplan-Meier Estimate
- Kidney Failure, Chronic
(etiology, urine)
- Male
- Middle Aged
- Observational Studies as Topic
- Prognosis
- Proportional Hazards Models
- Proteinuria
(etiology, urine)
- ROC Curve
- Randomized Controlled Trials as Topic
- Treatment Outcome
- Young Adult
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