Increased risk of cardiovascular disease in patients with primary membranous nephropathy2017-05-09 10:30
Primary membranous nephropathy is one of the most common causes of adult nephrotic syndrome (NS). The goal of PMN is to focus on the prevention of end-stage renal disease (ESRD), which occurs only after a few years, and other complications of NS may occur early in the disease. Venous thrombotic events (VTE) is the early complications of MN, for the clinical characteristics of VTE we have been very clear, and the main cause of cardiovascular events (CVE) of the arterial thrombotic events (ATE) risk degree is only limited coverage.
Professor Taewoo Lee of the University of North Carolina at Chapel Hill's UNC kidney center, in a retrospective study, looked at the risk of CVE associated with PMN in a retrospective study of patients with ESRD. The risk factors of CVE were evaluated by multivariate survival analysis in the context of ESRD competitive risk. Related articles published online 2016 in the Journal Kidney International.
Professor Taewoo Lee collected data from 404 patients with PMN in the glomerular disease assistance network group at the University of North Carolina at Chapel Hill (GDCN cohort). The risk factors of CVE were analyzed in detail, focusing on the severity of nephrotic syndrome. The results of this cohort were validated in a cohort of 557 patients with PMN who were enrolled in a separate cohort study, the University of Toronto, the (cohort).
In the GDCN PMN cohort of patients, 60% are male, the average age of 55 years, the average level of proteinuria was 8.7 g/ day, the average level of serum albumin in 2.5 g/dl patients, 62% of the estimated glomerular filtration rate eGFR >60 mL/min/ 1.73m2.
During a follow-up of up to 24.3 months, CVE was found in all of the 31 patients, with progression to ESRD in all of the 58 patients, and the other 6 patients died of other causes. 2/3 CVE occurred in the first 2 years after diagnosis, most patients have severe proteinuria and hypoproteinemia. In contrast, approximately 1/3 of CVE occurred 2 years after the diagnosis, and the levels of proteinuria and hypoproteinemia in patients with delayed CVE were not severe in patients with CVE.
The cumulative incidence of CVEs was 4.4%, 5.4%, and 8.2%, respectively, at the age of 1, 2, and 3 years after renal biopsy. At the same time, the cumulative incidence of ESRD was 5.6%, 8.9% and 11.9%, respectively. In the baseline level of eGFR was greater than 60 mL/min/1.73m2 patients, in the first 3 years after diagnosis, the incidence rate of more than ESRD CVE. In contrast, in patients with baseline eGFR levels of <60 mL/min/1.73m2, the cumulative incidence of ESRD was higher than that of CVE in the first 6 months after renal biopsy.
In univariate analysis, age, previous CVE history, and diabetes were significantly associated with CVE. Current smoking and previous history of smoking were not associated with an increased incidence of CVE. In addition to previously known risk factors for CVE, severe renal failure at baseline was associated with an increased likelihood of CVE. Changes in renal function and severity of NS were found to have an effect on the incidence of CVE.
The incidence and risk factors for CVE were also validated in another cohort of 557 patients with primary membranous nephropathy.
The results of this study confirm that in the early stages of PMN disease, patients are at increased risk of CVE, even more than the risk of ESRD. Therefore, the reduction of CVE in patients with PMN should be considered as a measure of treatment efficacy, and will reduce CVE as the focus of treatment intervention.