Evaluation of the Risk Prediction Models in Predicting Kidney Outcomes in Antiglomerular Basement Membrane Disease

Huang Kuang; Yi-Yang Zhao; Jin-Wei Wang; Zhao Cui; Ming-Hui Zhao; Xiao-Yu Jia

doi:10.1016/j.ekir.2023.12.011

Evaluation of the Risk Prediction Models in Predicting Kidney Outcomes in Antiglomerular Basement Membrane Disease

Kidney Int Rep. 2023 Dec 18;9(3):624-634. doi: 10.1016/j.ekir.2023.12.011. eCollection 2024 Mar.

Authors

Huang Kuang^{1

2

3

4

5}, Yi-Yang Zhao^{1

2

3

4

5}, Jin-Wei Wang^{1

2

3

4

5}, Zhao Cui^{1

2

3

4

5}, Ming-Hui Zhao^{1

2

3

4

5}, Xiao-Yu Jia^{1

2

3

4

5}

Affiliations

¹ Renal Division, Peking University First Hospital, Beijing, China.
² Institute of Nephrology, Peking University, Beijing, China.
³ Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.
⁴ Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China.
⁵ Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China.

Abstract

Introduction: A previous study showed that the renal risk score (RRS) was transferrable to antiglomerular basement membrane (anti-GBM) disease and proposed a risk stratification according to the need of renal replacement therapy (RRT) and the percentage of normal glomeruli (N). Herein, we analyzed the risk factors associated with kidney outcomes in patients with biopsy-proven anti-GBM disease and evaluated these 2 prognosis systems.

Methods: A total of 120 patients with biopsy-proven anti-GBM disease with complete clinicopathologic and outcome data were analyzed.

Results: The median time to kidney biopsy was 41 days (interquartile range [IQR]: 22-63 days). RRT and N were the only independent predictors of end-stage kidney disease (ESKD). Patients with N ≥10% were more likely to achieve ESKD-free outcomes, even in the subcohort of patients who underwent posttreatment biopsies (P < 0.001). N and serum creatinine at presentation (cut-off values 750 μmol/l and 1300 μmol/l) were 2 independent factors for predicting kidney recovery. The RRS and the risk stratification tool exhibited predictive value for ESKD and could be transferred to patients with kidney biopsy following treatment (Harrell's C statistic [C] = 0.738 and C = 0.817, respectively). However, a cross-over of outcomes among groups was observed in the risk stratification tool in long-term follow-up, when patients with RRT and N ≥10% achieved better kidney outcomes than those without RRT but N <10%.

Conclusion: Normal glomeruli percentage, even posttreatment, was a strong indicator for kidney outcomes, especially on long-term prognosis. Serum creatinine is a predictor for kidney recovery, independent of biopsy findings. The risk stratification tool for kidney survival was transferrable to patients with anti-GBM disease with biopsy following treatment in our cohort; however, this needs further validations for long-term outcomes.

Keywords: antiglomerular basement membrane disease; normal glomeruli; prognosis; renal replacement therapy; renal risk score.