Biopsy-proven CKD etiology and outcomes: the Chronic Kidney Disease Japan Cohort (CKD-JAC) study

Takayuki Hamano; Takahiro Imaizumi; Takeshi Hasegawa; Naohiko Fujii; Hirotaka Komaba; Masahiko Ando; Masaomi Nangaku; Kosaku Nitta; Hideki Hirakata; Yoshitaka Isaka; Takashi Wada; Shoichi Maruyama; Masafumi Fukagawa

doi:10.1093/ndt/gfac134

Biopsy-proven CKD etiology and outcomes: the Chronic Kidney Disease Japan Cohort (CKD-JAC) study

Nephrol Dial Transplant. 2023 Feb 13;38(2):384-395. doi: 10.1093/ndt/gfac134.

Authors

Takayuki Hamano^{1

2}, Takahiro Imaizumi^{3

4}, Takeshi Hasegawa^{5

6

7}, Naohiko Fujii⁸, Hirotaka Komaba⁹, Masahiko Ando³, Masaomi Nangaku¹⁰, Kosaku Nitta¹¹, Hideki Hirakata¹², Yoshitaka Isaka², Takashi Wada¹³, Shoichi Maruyama⁴, Masafumi Fukagawa⁹

Affiliations

¹ Department of Nephrology, Nagoya City University Graduate School of Medicine, Nagoya, Japan.
² Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan.
³ Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan.
⁴ Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
⁵ Showa University Research Administration Center.
⁶ Department of Hygiene, Public Health, and Preventive Medicine, Graduate School of Medicine.
⁷ Division of Nephrology, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan.
⁸ Medical and Research Center for Nephrology and Transplantation, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan.
⁹ Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan.
¹⁰ Division of Nephrology and Endocrinology, the University of Tokyo Hospital, Tokyo, Japan.
¹¹ Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan.
¹² Fukuoka Renal Clinic, Fukuoka, Japan.
¹³ Division of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan.

Abstract

Background: The Kidney Disease: Improving Global Outcomes guidelines advocate the cause-glomerular filtration rate (GFR)-albuminuria (CGA) classification for predicting outcomes. However, there is a dearth of data supporting the use of the cause of chronic kidney disease. This study aimed to address how to incorporate a prior biopsy-proven diagnosis in outcome prediction.

Methods: We examined the association of biopsy-proven kidney disease diagnoses with kidney failure with replacement therapy (KFRT) and all-cause death before KFRT in patients with various biopsy-proven diagnoses (n = 778, analysis A) and patients with diabetes mellitus labeled with biopsy-proven diabetic nephropathy (DN), other biopsy-proven diseases and no biopsy (n = 1117, analysis B).

Results: In analysis A, adding biopsy-proven diagnoses to the GFR-albuminuria (GA) classification improved the prediction of 8-year incidence of KFRT and all-cause death significantly regarding integrated discrimination improvement and net reclassification index. Fine-Gray (FG) models with KFRT as a competing event showed significantly higher subdistribution hazard ratios (SHRs) for all-cause death in nephrosclerosis {4.12 [95% confidence interval (CI) 1.11-15.2)], focal segmental glomerulosclerosis [3.77 (95% CI 1.09-13.1)]} and membranous nephropathy (MN) [2.91 (95% CI 1.02-8.30)] than in immunoglobulin A nephropathy (IgAN), while the Cox model failed to show significant associations. Crescentic glomerulonephritis had the highest risk of all-cause death [SHR 5.90 (95% CI 2.05-17.0)]. MN had a significantly lower risk of KFRT than IgAN [SHR 0.45 (95% CI 0.24-0.84)]. In analysis B, other biopsy-proven diseases had a lower risk of KFRT than biopsy-proven DN in the FG model, with death as a competing event [SHR 0.62 (95% CI 0.39-0.97)].

Conclusions: The CGA classification is of greater value in predicting outcomes than the GA classification.

Keywords: CKD; diabetic kidney disease; epidemiology; kidney biopsy; prognosis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Albuminuria / complications
Diabetic Nephropathies* / diagnosis
Diabetic Nephropathies* / epidemiology
Diabetic Nephropathies* / etiology
Disease Progression
Glomerular Filtration Rate
Glomerulonephritis, IGA* / pathology
Glomerulonephritis, Membranous* / complications
Humans
Japan / epidemiology
Renal Insufficiency, Chronic* / epidemiology
Renal Insufficiency, Chronic* / etiology
Renal Insufficiency, Chronic* / pathology