KRT for ESRD Due to Primary Glomerular Disease

Primary glomerular disease (PGD) is a leading cause of ESRD resulting in kidney replacement therapy (KRT). Using data from the European Renal Association (ERA) Registry, Samar Abd ElHafeez, MD, and others identified incidence of patients starting KRT for ESRD due to PGD. They also investigated these individuals’ survival and causes of mortality.

A total of 69,854 patients who began KRT for ESRD due to PGD between 2000 and 2019 were included in the study. The researchers further identified six PGD subgroups based on ERA primary renal disease codes and studied age and sex standardized incidence, trend of incidence, and survival.

The standardized incidence of KRT for ESRD due to PGD was 16.6 per million population (pmp). The PGDs with the highest incidence were IgA nephropathy (IgAN) and focal segmental glomerulosclerosis (FSGS), at 4.6 pmp and 2.6 pmp, respectively. Histologically nonexamined PGDs comprised more than 50% of cases in Serbia, Bosnia and Herzegovina, and Romania; these were also common in Greece, Estonia, Belgium, and Sweden. The incidence declined from 18.6 pmp in 2000 to 14.5 pmp in 2013, then stabilized. The likelihood of survival was more than 50% for all PGD subgroups. Crescentic glomerulonephritis demonstrated the highest risk of death (adjusted HR, 1.8 [95% CI, 1.6-1.9]) versus IgAN. The most common cause of death was cardiovascular disease (33.9%).

While the lack of kidney biopsy facilities in some countries may have affected the accuracy of results, the study demonstrates that there are substantial differences among countries in the incidence of KRT for ESRD due to PGD. The incidence and outcomes of KRT among different PGD subgroups should be considered when determining an individualized approach to care.

Source: Nephrology Dialysis Transplantation