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American Journal of Kidney Diseases

Mortality in Patients With IgA Nephropathy

      Background

      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.

      Predictor

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

      Outcomes

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

      Results

      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.

      Limitations

      Treatment during follow-up is not known.

      Conclusions

      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

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