American Journal of Kidney Diseases

Mortality in Patients With IgA Nephropathy


      Immunoglobulin A nephropathy (IgAN) is the most common glomerulonephritis globally. Few studies have investigated mortality in patients with IgAN compared with the age- and sex-adjusted general population.

      Study Design

      Cohort study with record linkage between the Norwegian Kidney Biopsy Registry, Norwegian Cause of Death Registry, and Norwegian Renal Registry.

      Setting & Participants

      633 patients diagnosed with IgAN in 1988-2004.


      Estimated glomerular filtration rate (eGFR), age, and sex.


      Deaths and causes of death before and after the onset of end-stage renal disease through 2008.


      Mean follow-up was 11.8 (range, 0-20.8) years. During the observation period, the observed number of deaths was 80 and the expected number was 42.1, resulting in a standardized mortality ratio (SMR) of 1.9 (95% CI, 1.5-2.4). Risk stratification based on initial eGFR showed that SMR was 1.0 (95% CI, 0.6-1.6) if eGFR was ≥60 mL/min/1.73 m2, 1.9 (95% CI, 1.3-2.8) if eGFR was 30-60 mL/min/1.73 m2, and 3.6 (95% CI, 2.6-5.0) in patients with eGFR <30 mL/min/1.73 m2. Renal replacement therapy (RRT) was initiated in 146 patients and 35 of the 80 deaths occurred after the start of RRT. The age- and sex-adjusted SMR was not increased significantly in the pre-RRT period (1.3; 95% CI, 1.0-1.7), but was increased after initiation of RRT (4.9; 95% CI, 3.5-7.0). The most common cause of death was cardiovascular disease, accounting for 45% of all deaths.


      Treatment during follow-up is not known.


      Mortality in patients with IgAN was twice the expected rate, but not significantly increased before RRT. The risk of end-stage renal disease was substantially higher than risk of death.

      Index Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Kidney Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • D'Amico G.
        The commonest glomerulonephritis in the world: IgA nephropathy.
        Q J Med. 1987; 64: 709-727
        • Floege J.
        • Feehally J.
        IgA nephropathy: recent developments.
        J Am Soc Nephrol. 2000; 11: 2395-2403
        • Levy M.
        • Berger J.
        Worldwide perspective of IgA nephropathy.
        Am J Kidney Dis. 1988; 12: 340-347
        • D'Amico G.
        Natural history of idiopathic IgA nephropathy: role of clinical and histological prognostic factors.
        Am J Kidney Dis. 2000; 36: 227-237
        • Geddes C.C.
        • Rauta V.
        • Gronhagen-Riska C.
        • et al.
        A tricontinental view of IgA nephropathy.
        Nephrol Dial Transplant. 2003; 18: 1541-1548
        • Alamartine E.
        • Sabatier J.C.
        • Guerin C.
        • Berliet J.M.
        • Berthoux F.
        Prognostic factors in mesangial IgA glomerulonephritis: an extensive study with univariate and multivariate analyses.
        Am J Kidney Dis. 1991; 18: 12-19
        • Barbour S.J.
        • Reich H.N.
        Risk stratification of patients with IgA nephropathy.
        Am J Kidney Dis. 2012; 59: 865-873
        • Berthoux F.
        • Mohey H.
        • Laurent B.
        • Mariat C.
        • Afiani A.
        • Thibaudin L.
        Predicting the risk for dialysis or death in IgA nephropathy.
        J Am Soc Nephrol. 2011; 22: 752-761
        • Cattran D.C.
        • Coppo R.
        • Cook H.T.
        • et al.
        The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classification.
        Kidney Int. 2009; 76: 534-545
        • Chacko B.
        • John G.T.
        • Neelakantan N.
        • et al.
        Presentation, prognosis and outcome of IgA nephropathy in Indian adults.
        Nephrology (Carlton). 2005; 10: 496-503
        • D'Amico G.
        Influence of clinical and histological features on actuarial renal survival in adult patients with idiopathic IgA nephropathy, membranous nephropathy, and membranoproliferative glomerulonephritis: survey of the recent literature.
        Am J Kidney Dis. 1992; 20: 315-323
        • Donadio J.V.
        • Grande J.P.
        IgA nephropathy.
        N Engl J Med. 2002; 347: 738-748
        • Goto M.
        • Wakai K.
        • Kawamura T.
        • Ando M.
        • Endoh M.
        • Tomino Y.
        A scoring system to predict renal outcome in IgA nephropathy: a nationwide 10-year prospective cohort study.
        Nephrol Dial Transplant. 2009; 24: 3068-3074
        • Roberts I.S.
        • Cook H.T.
        • Troyanov S.
        • et al.
        The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibility.
        Kidney Int. 2009; 76: 546-556
        • Foley R.N.
        • Murray A.M.
        • Li S.
        • et al.
        Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the United States Medicare population, 1998 to 1999.
        J Am Soc Nephrol. 2005; 16: 489-495
        • Go A.S.
        • Chertow G.M.
        • Fan D.
        • McCulloch C.E.
        • Hsu C.Y.
        Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization.
        N Engl J Med. 2004; 351: 1296-1305
        • Johnson E.S.
        • Thorp M.L.
        • Yang X.
        • Charansonney O.L.
        • Smith D.H.
        Predicting renal replacement therapy and mortality in CKD.
        Am J Kidney Dis. 2007; 50: 559-565
        • Keith D.S.
        • Nichols G.A.
        • Gullion C.M.
        • Brown J.B.
        • Smith D.H.
        Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization.
        Arch Intern Med. 2004; 164: 659-663
        • Patel U.D.
        • Young E.W.
        • Ojo A.O.
        • Hayward R.A.
        CKD progression and mortality among older patients with diabetes.
        Am J Kidney Dis. 2005; 46: 406-414
        • Rahman M.
        • Pressel S.
        • Davis B.R.
        • et al.
        Cardiovascular outcomes in high-risk hypertensive patients stratified by baseline glomerular filtration rate.
        Ann Intern Med. 2006; 144: 172-180
        • Forsblom C.
        • Harjutsalo V.
        • Thorn L.M.
        • et al.
        Competing-risk analysis of ESRD and death among patients with type 1 diabetes and macroalbuminuria.
        J Am Soc Nephrol. 2011; 22: 537-544
        • Menon V.
        • Wang X.
        • Sarnak M.J.
        • et al.
        Long-term outcomes in nondiabetic chronic kidney disease.
        Kidney Int. 2008; 73: 1310-1315
        • Rosolowsky E.T.
        • Skupien J.
        • Smiles A.M.
        • et al.
        Risk for ESRD in type 1 diabetes remains high despite renoprotection.
        J Am Soc Nephrol. 2011; 22: 545-553
        • Wolfe R.A.
        • Ashby V.B.
        • Milford E.L.
        • et al.
        Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant.
        N Engl J Med. 1999; 341: 1725-1730
        • Arend S.M.
        • Mallat M.J.
        • Westendorp R.J.
        • van der Woude F.J.
        • van Es L.A.
        Patient survival after renal transplantation; more than 25 years follow-up.
        Nephrol Dial Transplant. 1997; 12: 1672-1679
        • Churg J.
        IgA nephropathy.
        in: Glassock R. Renal Disease—Classification and Atlas of Glomerular Diseases. 2nd ed. Igaku-Shoin, New York, NY1995: 181-202
        • Bjorneklett R.
        • Vikse B.E.
        • Bostad L.
        • Leivestad T.
        • Iversen B.M.
        Long-term risk of ESRD in IgAN; validation of Japanese prognostic model in a Norwegian cohort.
        Nephrol Dial Transplant. 2012; 27: 1485-1491
        • Skali H.
        • Uno H.
        • Levey A.S.
        • Inker L.A.
        • Pfeffer M.A.
        • Solomon S.D.
        Prognostic assessment of estimated glomerular filtration rate by the new Chronic Kidney Disease Epidemiology Collaboration equation in comparison with the Modification of Diet in Renal Disease Study equation.
        Am Heart J. 2011; 162: 548-554
        • Ojo A.
        • Wolfe R.A.
        • Agodoa L.Y.
        • et al.
        Prognosis after primary renal transplant failure and the beneficial effects of repeat transplantation: multivariate analyses from the United States Renal Data System.
        Transplantation. 1998; 66: 1651-1659