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Abstract: TH-PO401

Histopathologic and Demographic Features Associated with ESRD and Death

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Schwantes-An, Tae-Hwi, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Moorthi, Ranjani N., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Phillips, Carrie L., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Eadon, Michael T., Indiana University School of Medicine, Indianapolis, Indiana, United States
Background

The ability to stratify risk for developing end-stage renal disease and death in those who undergo a kidney biopsy allows us to better prognosticate patients who are at higher risk. We hypothesize that histopathologic features in kidney biopsy specimens augment risk stratification for ESRD and death over and above a fully adjusted demographic and clinical model.

Methods

Data from 2,720 individuals who underwent a kidney biopsy from 2001 to 2015 from the Biobank Biopsy Cohort of Indiana were obtained. Natural language processing facilitated annotation of histopathologic features and discrete clinical data was added using bioinformatics methods. Primary outcome was defined as time to ESRD or death, whichever occurred earlier. Censoring was done at 5 year follow up. Using Cox proportional hazard models, we studied relationship between demographic variables, comorbidities, baseline clinical features, primary diagnosis, and histopathologic features.

Results

Within 5 years of biopsy, 625 (23.0%) patients reached the primary endpoint of ESRD or death. Survival analysis with demographic and clinical variables as covariates and stratification by baseline renal function, showed following histopathologic features stratifying risk for the primary outcome, glomerular obsolescence (Hazard Ratio 1.81, 95% CI, 1.42 to 2.32, Pvalue < 0.001), interstitial fibrosis and tubular atrophy (HR 1.61, 95% CI, 1.30 to 2.0, Pvalue < 0.001), arteriolar hyalinosis (HR 1.46, 95% CI, 1.15 to 1.85 Pvalue < 0.01), and nodular mesangial sclerosis (adjusted HR 1.44, 95% CI, 1.15 to 2.82 Pvalue <0.01).

Conclusion

Histopathologic features on kidney biopsy specimens further augmented risk prediction for ESRD and death when compared to models with demographic and clinical variables alone. Inclusion of histopathologic features in ESRD and death risk models facilitates improved prognostication.

Funding

  • NIDDK Support