Abstract: TH-PO152
Steroid Associated Side Effects in Patients with Glomerular Disease
Session Information
- Clinical Glomerular Disorders: FSGS, MN, MCD
November 02, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Glomerular
- 1005 Clinical Glomerular Disorders
Authors
- Oh, Gia J., Stanford University, Stanford, California, United States
- Gipson, Patrick E., University of Michigan, Ann Arbor, Michigan, United States
- Pesenson, Anne, The Polyclinic, Seattle, Washington, United States
- Selewski, David T., University of Michigan, Ann Arbor, Michigan, United States
- Kamil, Elaine S., Cedars Sinai Medical Center, Los Angelos, California, United States
- Massengill, Susan F., Levine Children's Hospital, Charlotte, North Carolina, United States
- Lafayette, Richard A., Stanford University, Stanford, California, United States
- Modes, Meg, Patient Advocate, Livonia, Michigan, United States
- Adler, Sharon G., Harbor-UCLA Medical Center, Torrance, California, United States
- Lee, Lauren, NephCure Kidney International, King of Prussia, Pennsylvania, United States
- Gipson, Debbie S., University of Michigan, Ann Arbor, Michigan, United States
- Eikstadt, Richard, University of Michigan, Ann Arbor, Michigan, United States
- Attalla, Samara, University of Michigan, Ann Arbor, Michigan, United States
- Modi, Zubin J., University of Michigan, Ann Arbor, Michigan, United States
- Waldo, Anne, University of Michigan, Ann Arbor, Michigan, United States
- Troost, Jonathan P., University of Michigan, Ann Arbor, Michigan, United States
Background
Steroid therapy is a common treatment for chronic glomerular disease with a goal of delaying or preventing end-stage kidney disease, but patients and families often express concerns about steroid-associated side effects (SA-SE). The goal of this study was to assess the occurrence of SA-SE in patients with primary proteinuric kidney disease.
Methods
736 patients with preserved native kidney function enrolled in NephCure Accelerating Cures Institute registry within electronic health record sourced database were available for analysis. ICD-9 and ICD-10 code sets were generated for SA-SEs including HTN, obesity, diabetes, short stature, cataracts, glaucoma, and psychosis. Measures (elevated BP > 3 times and BMI) were also used to identify HTN and obesity. These side effects were identified through analysis of inpatient and outpatient encounter data. Events were considered steroid-associated if they occurred after the onset of steroid exposure.
Results
413 of 736 (56%) registry patients were treated with steroids during study observation. Of these 413, 67% were adults, median age 41y, and 33% children, median age 11y, and the diagnoses were FSGS 26%, Membranous 11%, Minimal Change 19%, NS-not biopsied 16%, and other 29%. Median observation was 35 (IQR: 18-59) months. Table 1 presents SA-AE frequencies. 79% developed any SA-AE and 54% developed an event other than HTN. No episodes of glaucoma or psychosis were documented.
Conclusion
This study evaluated the incidence of medical encounter documented SA-AEs in patients with primary proteinuric kidney disease. The majority of patients treated with steroids developed at least one SA-AE. An accounting of the full patient experience of SA-AEs will likely require direct patient reported information to enrich the medical documentation.
Table 1. Frequencies of SA-AEs among steroid treated proteinuric kidney disease patients by age group
| All Patients on steroids (n=413) | Patients < 18 y on steroids (n=159) | Patients >=18 y on steroids (n=254) | P value | |
| Hypertension | 289 (70) | 131 (82) | 158 (62) | <0.01 |
| Obesity | 173 (42) | 76 (48) | 97 (38) | 0.05 |
| Diabetes | 44 (11) | 8 (5) | 36 (14) | <0.01 |
| Short stature | 16 (4) | 10 (6) | 6 (2) | 0.04 |
| Cataracts | 11 (3) | 2 (1) | 9 (4) | 0.16 |
| >=1 SA-AE beyond HTN | 221 (54) | 128 (50) | 93 (58) | 0.11 |
Funding
- Private Foundation Support