Abstract
Introduction The identification of reliable prognostic factors is a crucial requirement for patients with IgA nephropathy (IgAN). Here, we explored the relationship between serum chloride levels and prognosis in patients with IgAN. Methods We recruited all patients with primary IgAN, as diagnosed by renal biopsy, between 1st January 2015 and 1st April 2019. Patients were divided two groups (high chloride group and low chloride group) based on the best cut-off values from survival receiver operating characteristic (ROC) curves. The baseline clinicopathological characteristics of two groups were then compared. Cox proportional hazard models were used to determine the prognostic value of serum chloride levels in patients with IgAN. Finally, we screened reliable prognostic indicators and built a clinical prediction model and validated the performance of the model. Results Compared with patients in the high chloride group, patients in the low chloride group had significantly lower levels of 24-hour urinary total protein (24 h-UTP), serum creatinine (sCr), and higher levels of hemoglobin (Hb), albumin (all p < 0.05), and less proportion of Oxford classification grade E1 (endothelial cell proliferation) and T2 (renal tubule atrophy or renal interstitial fibrosis). Cox analysis revealed that serum chloride level ≥ 105.4 mmol/L was a significant and independent risk factor for prognosis in patients with IgAN (p < 0.05). Serum chloride, sCr, T, hypertension, and Hb were used to generate a predictive model for prognosis. Thec-indices of our predictive model were 0.80, 0.86, and 0.78, for 1, 2, and 3 years, respectively; Brier scores were 0.06, 0.09, and 0.16, respectively. Conclusions A serum chloride level ≥ 105.4 mmol/l was identified as a significant and independent risk factor for the prognosis of patients with IgAN. A predictive prognosis model was generated using serum chloride, sCr, T, hypertension, and Hb; this model exhibited a good predictive effect.
Highlights
The identification of reliable prognostic factors is a crucial requirement for patients with immunoglobulin A (IgA) nephropathy (IgAN)
The most accepted pathogenic mechanism underlying IgA nephropathy (IgAN) relates to the “multiple hits” theory [2], “Hit-1,” production of galactosedeficient IgA1 (Gd-IgA1) in circulation, “Hit-2,” production of antibodies against Gd-IgA1, “Hit-3,” formation of GdIgA1 containing circulating immune complex (CIC), and “Hit-4,” deposition of CIC in kidney that contributes to renal injury
The inclusion criteria included the following items: (1) primary IgAN was diagnosed by renal biopsy, (2) the follow-up time was more than 6 months, and (3) no glucocorticoid or immunosuppressants were used before renal biopsy and (4) an initial estimated glomerular filtration rate ðeGFRÞ ≥ 15 mL/min/1:73 m2 at the time of renal biopsy
Summary
The identification of reliable prognostic factors is a crucial requirement for patients with IgA nephropathy (IgAN). Cox proportional hazard models were used to determine the prognostic value of serum chloride levels in patients with IgAN. Cox analysis revealed that serum chloride level ≥ 105:4 mmol/L was a significant and independent risk factor for prognosis in patients with IgAN (p < 0:05). A serum chloride level ≥ 105:4 mmol/l was identified as a significant and independent risk factor for the prognosis of patients with IgAN. Researchers have gradually identified a number of predictors for the prognosis of patients with IgAN based on clinical, pathological, genetic, and noninvasive biological markers [5]. These parameters are associated with poor sensitivity, trauma, and high costs.
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