A national registry study of patient and renal survival in adult nephrotic syndrome

Anna Kolb, Jacqueline Campbell, Martin O'Neill, James R. Smith, Samira Bell, Bryan R. Conway, Wendy Metcalfe, Nicola Joss, Vishal Dey, Annette Alfonzo, Michael Kelly, Shahzad Shah, Emily McQuarrie, Colin Geddes, Jamie Traynor, Robert W. Hunter (Lead / Corresponding author), Scottish Renal Biopsy Registry

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Abstract

Introduction: We aimed to determine the mortality rate, cause of death, and rate of end-stage kidney disease (ESKD) in adults with nephrotic syndrome (NS).

Methods: We conducted a national registry–based study, including all 522 adults who had a kidney biopsy for NS in Scotland in 2014–2017. We linked the Scottish Renal Registry to death certificate data. We performed survival and Cox proportional hazards analyses, accounting for competing risks of death and ESKD. We compared mortality rates with those in the age- and sex-matched general population. 

Results: A total of 372 patients had primary NS; 150 had secondary NS. Over a median follow-up of 866 days, 110 patients (21%) died. In patients with primary NS, observed versus population 3-year mortality was 2.1% (95% CI 0.0%–4.6%) versus 0.9% (0.8%–1.0%) in patients aged <60 years and 24.9% (18.4%–30.8%) versus 9.4% (8.3%–10.5%) in those aged ≥60 years. In secondary NS, this discrepancy was 17.1% (5.6%–27.2%) versus 1.1% (0.9%–1.2%) in <60-year-olds and 49.4% (36.6%–59.7%) versus 8.1% (6.6%–9.6%) in ≥60-year-olds. In primary NS, cardiovascular causes accounted for 28% of deaths, compared with 18% in the general population. Eighty patients (15%) progressed to ESKD. Incidence of ESKD by 3 years was 8.4% (95% CI 4.9%–11.7%) in primary and 35.1% (24.3%–44.5%) in secondary NS. Early remission of proteinuria and the absence of early acute kidney injury (AKI) were associated with lower rates of death and ESKD.

Conclusions: Adults with NS have high rates of death and ESKD. Cardiovascular causes account for excess mortality in primary NS.

Original languageEnglish
Pages (from-to)449-459
Number of pages11
JournalKidney International Reports
Volume6
Issue number2
Early online date4 Nov 2020
DOIs
Publication statusPublished - 1 Feb 2021

Keywords

  • nephrotic syndrome
  • glomerular disease
  • minimal change nephropathy
  • mortality
  • ESKD
  • cardiovascular disease
  • minimal-change nephropathy

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