Abstract
BackgroundMembranoproliferative glomerulonephritis (MPGN) is an uncommon cause of end stage kidney disease (ESKD) and the clinical outcomes of patients with MPGN who commence kidney replacement therapy have not been comprehensively studied.MethodsAll adult patients with ESKD due to glomerulonephritis commencing kidney replacement therapy in Australia and New Zealand from January 1, 1996 to December 31, 2016 were reviewed. Patients with ESKD due to MPGN were compared to patients with other forms of glomerulonephritis. Patient survival on dialysis and following kidney transplantation, kidney recovery on dialysis, time to transplantation, allograft survival, death-censored allograft survival and disease recurrence post-transplant were compared between the two groups using Kaplan Meier survival curves and Cox proportional hazards regression.ResultsOf 56,481 patients included, 456 (0.8%) had MPGN and 12,660 (22.4%) had another form of glomerulonephritis. Five-year patient survival on dialysis and following kidney transplantation were similar between patients with ESKD from MPGN and other forms of glomerulonephritis (Dialysis: 59% vs. 62% p = 0.61; Transplant: 93% vs. 93%, p = 0.49). Compared to patients with other forms of glomerulonephritis, patients with MPGN had significantly poorer 5-year allograft survival (70% vs. 81% respectively, p = 0.02) and death censored allograft survival (74% vs. 87%, respectively; p < 0.01). The risk of disease recurrence was significantly higher in patients with MPGN compared to patients with other glomerulonephritidites (18% vs. 5%; p < 0.01). In patients with MPGN who had allograft loss, patients with MPGN recurrence had a significantly shorter time to allograft loss compared to patients with MPGN who had allograft loss due to any other cause (median time to allograft loss 3.2 years vs. 4.4 years, p < 0.01).ConclusionsCompared with other forms of glomerulonephritis, patients with MPGN experienced comparable rates of survival on dialysis and following kidney transplantation, but significantly higher rates of allograft loss due to disease recurrence.
Highlights
Membranoproliferative glomerulonephritis (MPGN) is an uncommon cause of end stage kidney disease (ESKD) and the clinical outcomes of patients with MPGN who commence kidney replacement therapy have not been comprehensively studied
Recent advances in the understanding of the pathophysiology of MPGN have resulted in the reclassification of MPGN into two entities based on the mechanism of immune injury to the glomerulus: C3 glomerulonephritis (C3GN) and immune complex MPGN (ICGN) [7]
This has been attributed to an increased risk of disease recurrence in MPGN compared to other forms of glomerulonephritis (GN) [1, 11]
Summary
Study population Data were obtained from patients enrolled in the ANZDATA registry. All patients with ESKD from January 1, 1996 to December 31, 2016 in Australia and New Zealand were included (Additional file 1: Figure S1). Data collection Baseline characteristics were evaluated at the initiation of dialysis or, if pre-emptively transplanted, at the time of transplantation They included age, sex, ethnicity, smoking status, hepatitis C antibody status, diabetes mellitus, chronic lung disease, coronary artery disease, peripheral vascular disease, cerebrovascular disease and any previous diagnosis of cancer. Secondary outcomes evaluated included cause of death, kidney function recovery on dialysis, time to transplantation, allograft survival, cause of allograft loss and disease recurrence post-transplant. Propensity scores were calculated using a logistic regression model for the likelihood of developing MPGN using patient age, sex, ethnicity, all available co-morbidities, late referral for KRT, and dialysis or transplantation era. Patient survival on dialysis was censored for kidney function recovery, loss to follow-up, kidney transplantation and end of study. ATSI Aboriginal and Torres Strait Islander, HD Hemodialysis, KRT Kidney replacement therapy, MPI Maori and Pacific islander, PD Peritoneal dialysis values less than 0.05 were deemed statistically significant
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