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Kidney Int. 2016 May;89(5):1111-1118. doi: 10.1016/j.kint.2015.12.041. Epub 2016 Feb 26.

Patients with primary membranous nephropathy are at high risk of cardiovascular events.

Author information

1
UNC Kidney Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea.
2
UNC Kidney Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
3
Biostatistics Department, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
4
Laiko Hospital, Athens, Greece.
5
Division of Nephrology, Department of Medicine, University of Toronto, and Toronto Glomerulonephritis Registry, University Health Network, Toronto, Ontario, Canada.
6
UNC Kidney Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. Electronic address: patrick_nachman@med.unc.edu.

Abstract

Here we conducted a retrospective study to examine the risk of cardiovascular events (CVEs) relative to that of end-stage renal disease (ESRD) in patients with primary membranous nephropathy, in a discovery cohort of 404 patients. The cumulative incidence of CVEs was estimated in the setting of the competing risk of ESRD with risk factors for CVEs assessed by multivariable survival analysis. The observed cumulative incidences of CVEs were 4.4%, 5.4%, 8.2%, and 8.8% at 1, 2, 3, and 5 years respectively in the primary membranous nephropathy cohort. In the first 2 years after diagnosis, the risk for CVEs was similar to that of ESRD in the entire cohort, but exceeded it among patients with preserved renal function. Accounting for traditional risk factors and renal function, the severity of nephrosis at the time of the event (hazard ratio 2.1, 95% confidence interval 1.1 to 4.3) was a significant independent risk factor of CVEs. The incidence and risk factors of CVEs were affirmed in an external validation cohort of 557 patients with primary membranous nephropathy. Thus early in the course of disease, patients with primary membranous nephropathy have an increased risk of CVEs commensurate to, or exceeding that of ESRD. Hence, reduction of CVEs should be considered as a therapeutic outcome measure and focus of intervention in primary membranous nephropathy.

KEYWORDS:

cardiovascular disease; glomerulonephritis; membranous nephropathy

PMID:
26924046
DOI:
10.1016/j.kint.2015.12.041
[Indexed for MEDLINE]

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