Develop and Validate a Risk Score in Predicting Renal Failure in Focal Segmental Glomerulosclerosis

Yikai Cai; Yunzi Liu; Jun Tong; Yuanmeng Jin; Jian Liu; Xu Hao; Yinhong Ji; Jun Ma; Xiaoxia Pan; Nan Chen; Hong Ren; Jingyuan Xie

doi:10.1159/000529773

Develop and Validate a Risk Score in Predicting Renal Failure in Focal Segmental Glomerulosclerosis

Kidney Dis (Basel). 2023 Mar 28;9(4):285-297. doi: 10.1159/000529773. eCollection 2023 Aug.

Authors

Yikai Cai¹, Yunzi Liu¹, Jun Tong¹, Yuanmeng Jin¹, Jian Liu¹, Xu Hao¹, Yinhong Ji¹, Jun Ma¹, Xiaoxia Pan¹, Nan Chen¹, Hong Ren¹, Jingyuan Xie¹

Affiliation

¹ Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Abstract

Introduction: The aim of this study was to develop and validate a risk score (RS) for end-stage kidney disease (ESKD) in patients with focal segmental glomerulosclerosis (FSGS).

Methods: Patient with biopsy-proven FSGS was enrolled. All the patients were allocated 1:1 to the two groups according to their baseline gender, age, and baseline creatinine level by using a stratified randomization method. ESKD was the primary endpoint.

Results: We recruited 359 FSGS patients, and 177 subjects were assigned to group 1 and 182 to group 2. The clinicopathological variables were similar between two groups. There were 23 (13%) subjects reached to ESKD in group 1 and 22 (12.1%) in group 2. By multivariate Cox regression analyses, we established RS 1 and RS 2 in groups 1 and 2, respectively. RS 1 consists of five parameters including lower eGFR, higher urine protein, MAP, IgG level, and tubulointerstitial lesion (TIL) score; RS 2 also consists of five predictors including lower C3, higher MAP, IgG level, hemoglobin, and TIL score. RS 1 and RS 2 were cross-validated between these two groups, showing RS 1 had better performance in predicting 5-year ESKD in group 1 (c statics, 0.86 [0.74-0.98] vs. 0.82 [0.69-0.95]) and group 2 (c statics, 0.91 [0.83-0.99] vs. 0.89 [0.79-0.99]) compared to RS 2. We then stratified the risk factors into four groups, and Kaplan-Meier survival curve revealed that patients progressed to ESKD increased as risk levels increased.

Conclusions: A predictive model incorporated clinicopathological feature was developed and validated for the prediction of ESKD in FSGS patients.

Keywords: Clinicopathological features; Focal segmental glomerulosclerosis; Predictive model; Survival analysis.

Grants and funding

This work was supported by grants from the Major International (Regional) Joint Research Program of National Natural Science Foundation of China (No. 82120108007), the National Natural Science Foundation of China (No. 81870460, 81570598, 81370015), Program of Shanghai Academic/Technology Research Leader (No. 21XD1402000), Science and Technology Innovation Action Plan of Shanghai Science and Technology Committee (No. 22140904000, 17441902200), Shanghai Municipal Education Commission Gaofeng Clinical Medicine Grant (No. 20152207), Shanghai Shenkang Hospital Development Center “Three-year Action Plan for Promoting Clinical Skills and Clinical Innovation in Municipal Hospitals” (No. SHDC2020CR6017), and Shanghai Jiaotong University “Jiaotong Star” Plan Medical Engineering Cross Research Key Project (No. YG2019ZDA18). The funding bodies had no role in the design of the study, collection, analysis, and interpretation of data, or the writing of the manuscript.