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Kidney Week

Abstract: PO1935

Epidemiology of Medical Kidney Disease in the Southwestern United States, 1989-2018

Session Information

Category: Pathology and Lab Medicine

  • 1600 Pathology and Lab Medicine

Authors

  • Takahashi, Akira, Cedars-Sinai Medical Center, Los Angeles, United States
  • Miyauchi, Takamasa, Cedars-Sinai Medical Center, Los Angeles, California, United States
  • Ren, Yi Mi Kevin, Cedars-Sinai Medical Center, Los Angeles, California, United States
  • Doi, Toshiki, Hiroshima University Hospital, Hiroshima, Japan
  • Masaki, Takao, Hiroshima University Hospital, Hiroshima, Japan
  • Yamashita, Michifumi, Cedars-Sinai Medical Center, Los Angeles, California, United States
Background

Kidney biopsy is the main source of epidemiological information for kidney disease. However, large-scale epidemiological studies for glomerular disease (GD) in the US are very limited, and there are no such studies for non-glomerular disease (non-GD). Here, we describe 30-year temporal and demographic trends in GDs and non-GDs in the southwestern US between 1989 and 2018.

Methods

In this retrospective study, all kidney biopsy data at Pathology, Cedars-Sinai Medical Center (CSMC), Los Angeles, CA, between 1989 and 2018 were reviewed. We analyzed the most common 26 GDs and the most common 9 non-GDs. The frequencies of GD and non-GD subtypes and the temporal trends in each disease subtype within demographic subgroup were our primary and secondary outcomes. In addition, the frequency distribution of each disease category was evaluated across age categories stratified by sex and race.

Results

Among 48,068 patients (mean age =50.3 ± 19.3 y.o.; 52.0% men; 55.5% white; 18.4% Latino; 11.1% black; 9.8% Asian; 5.2% others), GD and non-GD composed 83.4% and 16.6% of all biopsies, respectively. In GDs, the frequency of diabetic glomerulosclerosis increased over the three decades (8.4%, 12.2%, and 22.0% of diagnoses; P for trend <0.003). The frequency of FSGS, lupus nephritis, immune complex-glomerulonephritis (GN), membranous nephropathy, and minimal change disease declined substantially over time. On the other hand, IgAN and ANCA/pauci-immune GN remained stable. In non-GDs, nephrosclerosis was the most frequent in study period. However, acute tubular necrosis/injury slightly increased over time and became the most common subtype in the latest 10 years. These temporal trends were largely preserved within all demographic subgroups, although cross-sectional frequency distributions differed according to age, sex, and race.

Conclusion

We reported the largest epidemiological study of medical kidney disease in the US. The relative renal biopsy frequencies of many GDs and non-GDs showed significant changes over the three decades in the southwestern US. Temporal trends were consistently observed within all major demographic groups. We provided evidence that changes in demographics (age, sex, and race) contributed minimally to these findings, suggesting that environmental and lifestyle changes contribute to them.