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Kidney Week

Abstract: FR-PO1134

Kidney Outcome with Primary Focal Segmental Glomerulosclerosis (FSGS) by Using a Predictive Model

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Ossareh, Shahrzad, Iran University of Medical Sciences, Hasheminejad Kidney Center, Tehran, Tehran, Iran (the Islamic Republic of)
  • Yahyaei, Mansoureh, Iran University of Medical Sciences, Hasheminejad Kidney Center, Tehran, Tehran, Iran (the Islamic Republic of)
  • Asgari, Mojgan, Iran University of Medical Sciences- Hasheminejad Kidney center, Tehran, Iran (the Islamic Republic of)
  • Afghahi, Hanri, Skaraborg Hospital, Skövde, Sweden
Background

To develop a model of prediction of chronic kidney disease (CKD)/ end- stage kidney disease (ESKD) (dialysis or kidney transplantation) in patients with primary FSGS by baseline clinical, laboratory and pathological findings as predictors.

Methods

201 patients with primary FSGS (59% male, mean age: 38±15 years, baseline serum creatinine (bSCr): 1.89±1.64 mg/dl, eGFR 65±38 ml/min/1.73 m2 (MDRD) and mean proteinuria: 4.6±3.6 g/24 hours were followed. Time-dependent Cox model and C statistics for discrimination were used to develop a predictive model. The patients were classified into 3 risk groups of low (bSCr<1.5 mg/dl and interstitial fibrosis/ tubular atrophy (IF/TA) and segmental glomerulosclerosis (SGS)< 25%, medium (bSCr: 1.5- 2 mg/dl, and IF/TA and SGS: 25-50%) and high (bSCr>2 mg/dl and IF/TA and SGS> 50%). Kaplan–Meier and the log-rank tests were used to estimate kidney survival in each group. Interaction between independent variables was estimated.

Results

During the mean follow-up of 55±27 months, 46 patients (23%) developed CKD and 36 (18%) ESKD. Ninety patients (44%) did not respond to treatment and among them, 76 patients (84%) developed CKD/ESKD.
In multivariate model 1 mg/dl higher bSCr (HR: 1.63, 95% CI: 1.12-2.37), 1% increase in SGS (HR: 1.04, 95% CI: 1.01-1.08) and 1% increase in IF/TA (HR: 1.06, 95% CI: 1.03-1.09)in kidney biopsy, were associated with increased risk.
In adjusted model, higher baseline proteinuria and collapsing variant (NOS variant as reference) were not significantly associated with risk of CKD/ESKD (P=0.671 and P=0.136, respectively).
The median kidney survival was 8.1 years (95% CI, 7.7-8.6 years) in low risk and 3.1 years (95%, 2.2- 4.1 years) in high-risk patients.
In prediction model the accuracy of the applied score for prediction of CKD with discrimination by C statistics was C= 0.84 (95% CI: 0.78-0.91) for 5 years.

Conclusion

In patients with primary FSGS, higher bSCr, SGS and IF/TA scores were the strongest predictors for CKD/ESKD. In adjusted model higher proteinuria at baseline was not associated with increased risk of CKD/ESKD. Interestingly collapsing variant did not increase the risk of CKD/ESKD after adjustment for IF/TA score. These findings indicated the importance of baseline GFR and the degree of chronicity at biopsy rather than histologic variants as predictors of kidney outcome.