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Abstract: SA-PO652

Prognostic Impact of Interstitial Fibrosis for Progression to ESRD in ANCA-GN

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Bostad, Lars Sigurd, Haukeland University Hospital, Bergen, Norway
  • Bostad, Leif, Haukeland University Hospital, Bergen, Norway
  • Fismen, Anne-Siri, Western Norway University of Applied Sciences, Bergen, Norway
  • Bjoerneklett, Rune, Haukeland University Hospital, Bergen, Norway
Background


Interstitial fibrosis (IF) is a well-known risk factor for progression to ESRD in patients with glomerulonephritis (GN). However, few studies have reported its role as an independent risk factor as determined by multivariate analysis on patients with ANCA-GN.

Methods


Patients with ANCA-GN and IF graded as none-mild focal (<25%)/severe focal (25-50%)/diffuse (>50%) and other base-line risk factors, were obtained from the Norwegian Kidney Biopsy Registry. The observation period was from the date of biopsy to date of ESRD/death/end of 2013. ESRD and deaths during follow-up were identified by record linkage with The Norwegian Renal Registry. The primary end-point of the study was progression to ESRD within 3-years after diagnosis of ANCA-GN. Cox-regression statistics with and without adjustment for eGFR, glomerular classification (focal/crescentic/mixed/sclerotic), age, gender, ANCA sero-type was used to calculate HR`s of ESRD between the different grades of IF.

Results


Two-hundred-fifty patients were identified of whom 43 progressed to ESRD within 3-years after diagnosis of ANCA-GN. Severe focal versus mild focal IF: Unadjusted HR 3.1 (1.6-6.1) p<0.001 and adjusted HR 2.1 (1.0-4.2) p=0.04. Diffuse versus mild focal IF: Unadjusted HR 5.7 (2.6-12.6) p<0.001 and adjusted HR 2.3 (0.9-5.6) p=0.07. Diffuse or severe focal versus mild focal IF: Unadjusted HR 3.8 (2.1-7.0) p<0.001 and adjusted HR 2.0 (1.1-3.9) p=0.03. Diffuse versus severe focal: Unadjusted HR 1.9 (0.9-4.4) p=0.11 and adjusted HR 0.8 (0.3-2.0) p=0.63.

Conclusion


Unadjusted, increasing degrees of IF is a strong risk factor for progression to ESRD in ANCA-GN. Adjusted for other known risk factors IF < versus ≥25% is a moderate independent predictor of progression to ESRD in ANCA-GN. Our finding suggests that IF should be included in multi-factor models aiming at predicting risk of progression to ESRD in ANCA-GN.