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Kidney Week

Abstract: FR-PO869

Calcineurin Inhibitors Treatment and Renal Function Decline in Patients with Idiopathic Membranous Nephropathy

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Xie, Huaiya, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
  • Li, Chao, Division of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, BeiJing, China
  • Wen, Yubing, Division of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, BeiJing, China
  • Ye, Wei, Division of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, BeiJing, China
  • Cai, Jianfang, Division of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, BeiJing, China
  • Li, Hang, Division of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, BeiJing, China
  • Li, Xuemei, Division of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, BeiJing, China
  • Li, Xuewang, Division of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, BeiJing, China
Background

Calcineurin inhibitors (CNIs), including cyclosporine A(CSA) and tacrolimus, is an established therapeutic option suggested for treatment in IMN patients. The major concern with CNIs remains its propensity to induce renal function impairment. This study was designed to assess the influence of CNIs on renal function compared with cyclophosphamide(CTX), and seek factors that can predict renal function impairment in patients receiving CSA.

Methods

In this study, we included 555 IMN patients treated with CTX or CNIs, with or without glucocorticoids and other immunosuppressant. Data on age, sex, body mass index, presence of hypertension and diabetes, laboratory tests, and therapeutic regimens were retrospectively retrieved from medical record. Cox regression was employed to analyze risk factors indicating a 30% decline in estimate glomerular filtration rate(eGFR) or end-stage renal disease (ESRD) in total patients or those treated with CSA.

Results

During a median follow up of 2.9(1.0-4.6) years, 59(10.6%) patients developed a 30% eGFR decline or ESRD, of whom over 90% had been treated with CNIs before. CNIs treatment was an independent risk factors associated with developing 30% decline in eGFR or ESRD (HR=5.7, 95%CI 2.2-14.8, P<0.001), independently of age, sex, hypertension, baseline serum albumin, urine protein, and eGFR, and the dose of glucocorticoids. Further analysis restricted in patients receiving CSA showed age over 50 years old (HR=3.7, 95%CI 1.8-7.3, P<0.001) and mean CSA dose over 2.2mg/kg/d (HR=1.8, 95%CI 1.0-3.1, P=0.035) might indicate 30% decline in eGFR or ESRD.

Conclusion

CNIs treatment may associate with renal function decline independently in IMN patients, especially in patients over 50 years old or receiving CSA over 2.2mg/kg/d.