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Kidney Week

Abstract: SA-PO153

Association Between Monoclonal Gammopathy of Undetermined/Renal Significance (MGUS/MGRS) and ESKD and Mortality in Patients With CKD

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Sy-Go, Janina Paula Tiulentino, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Moubarak, Simon, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Viehman, Jason K., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Vaughan, Lisa E., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Fervenza, Fernando C., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Zand, Ladan, Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background

Little is known about the prognostic significance of MGUS/MGRS in patients with CKD. The objective of this study was to determine the association between MGUS/MGRS and ESKD and mortality in patients with CKD.

Methods

We identified 109,638 adult patients with CKD at Mayo Clinic from January 1, 2013 to December 31, 2018. We excluded those who did not have monoclonal (M) protein testing (n=98,270). Of 4558 patients, 3142 were diagnosed with MGUS based on positive M protein by either SPEP/UPEP confirmed by immunofixation or abnormal FLC ratio while 64 were considered to have an MGRS lesion based on biopsy.

Results

We identified a total of 1535 patients (828 with no MGUS, 648 with MGUS, and 59 with MGRS). Median age was 73.5 years (65.3,80.2), and 57.9% were male. Median eGFR was 45 mL/min/1.73m2. Median follow-up was 4.86 years. Patients with MGRS were younger (68.5 years) and had lower eGFR (41 mL/min/1.73m2) and higher proteinuria. Patients with MGRS also had the highest mortality compared to those with MGUS and no MGUS with infection being the most common known cause of death (25%). MGRS was associated with an increased risk of ESKD in unadjusted model, but after adjustment for eGFR, it was no longer significant (Table 1). MGUS was also associated with an increased risk of ESKD compared to no MGUS in unadjusted model and after adjusting for age, sex, eGFR, and proteinuria, but after adjusting for comorbidities, it was no longer significant (Table 1).

Conclusion

MGUS and MGRS are not independently associated with a higher risk of ESKD in patients with CKD after adjusting for other clinical characteristics. Patients with MGRS had higher rates of death compared to the other groups.

Unadjusted and Adjusted Associations Between Non-MGUS/MGRS, MGUS, and MGRS Status and Risk of ESKD
 MGUSMGRS
Adjusting VariablesHR (95% CI) PHR (95% CI P
Unadjusted1.250 (0.967, 1.615) 0.0882.534 (1.517, 4.235) <0.001
Age1.243 (0.961, 1.608) 0.0982.016 (1.183, 3.435) 0.010
Sex1.256 (0.970, 1.626) 0.0842.565 (1.526, 4.310) <0.001
eGFR1.378 (1.062, 1.786) 0.0161.759 (0.935, 3.309) 0.080
Age, sex, eGFR1.369 (1.055, 1.776) 0.0181.461 (0.760, 2.809) 0.256
Age, sex, eGFR, proteinuria1.369 (1.041, 1.801) 0.0250.824 (0.415, 1.636) 0.580
Age, sex, eGFR, Charlson Comorbidity Index1.266 (0.973, 1.648) 0.0791.575 (0.798, 3.109) 0.190
Age, sex, eGFR, proteinuria, Charlson Comorbidity Index1.248 (0.948, 1.644) 0.1140.906 (0.450, 1.825) 0.783