Secular trends in the incidence of end-stage renal disease and its risk factors in Japanese patients with immunoglobulin A nephropathy

Shigeru Tanaka, Toshiharu Ninomiya, Ritsuko Katafuchi, Kosuke Masutani, Akihiro Tsuchimoto, Masanori Tokumoto, Hideki Hirakata, Hiroaki Ooboshi, Takanari Kitazono, Kazuhiko Tsuruya

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Abstract

Background There are limited data on secular trends in the incidence of end-stage renal disease (ESRD) and frequencies of its risk factors or treatment modalities in patients with immunoglobulin A nephropathy (IgAN). Methods This study divided 1255 patients with IgAN into three groups according to the timing of renal biopsy: 1979-89 (n = 232), 1990-99 (n = 574) and 2000-10 (n = 449). The age-adjusted incidence rates, incidence rate ratios and 95% confidence intervals (CIs) for ESRD were calculated by the person-year method and compared using Poisson regression analysis. Results A total of 63 patients (5.0%) developed ESRD. The age-adjusted incidence of ESRD decreased significantly over time, i.e. 11.5 per 1000 person-years (95% CI 5.4-24.6) in 1979-89, 6.5 per 1000 person-years (95% CI 1.0-25.2) in 1990-99 and 4.2 per 1000 person-years (95% CI 1.0-17.7) in 2000-10. The proportions of patients with preserved renal function and acute-stage inflammatory histologic changes (i.e. endocapillary hypercellularity and extracapillary proliferation) at the timing of biopsy increased over time, as did the rates of prescriptions of renin-angiotensin system blockers and corticosteroids (all P for trend <0.05). The effect of acute inflammatory histologic lesions on renal prognosis was drastically reduced over time. Conclusions These findings suggest that early diagnosis in the acute inflammatory phase and subsequent aggressive treatment may have contributed to the significant downward trend in the incidence of ESRD in patients with IgAN over three decades.

Original languageEnglish
Pages (from-to)963-971
Number of pages9
JournalNephrology Dialysis Transplantation
Volume33
Issue number6
DOIs
Publication statusPublished - Jun 1 2018

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IGA Glomerulonephritis
Chronic Kidney Failure
Confidence Intervals
Incidence
Kidney
Biopsy
Renin-Angiotensin System
Prescriptions
Early Diagnosis
Adrenal Cortex Hormones
Regression Analysis
Therapeutics

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Transplantation

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Secular trends in the incidence of end-stage renal disease and its risk factors in Japanese patients with immunoglobulin A nephropathy. / Tanaka, Shigeru; Ninomiya, Toshiharu; Katafuchi, Ritsuko; Masutani, Kosuke; Tsuchimoto, Akihiro; Tokumoto, Masanori; Hirakata, Hideki; Ooboshi, Hiroaki; Kitazono, Takanari; Tsuruya, Kazuhiko.

In: Nephrology Dialysis Transplantation, Vol. 33, No. 6, 01.06.2018, p. 963-971.

Research output: Contribution to journalArticle

Tanaka, Shigeru ; Ninomiya, Toshiharu ; Katafuchi, Ritsuko ; Masutani, Kosuke ; Tsuchimoto, Akihiro ; Tokumoto, Masanori ; Hirakata, Hideki ; Ooboshi, Hiroaki ; Kitazono, Takanari ; Tsuruya, Kazuhiko. / Secular trends in the incidence of end-stage renal disease and its risk factors in Japanese patients with immunoglobulin A nephropathy. In: Nephrology Dialysis Transplantation. 2018 ; Vol. 33, No. 6. pp. 963-971.
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T1 - Secular trends in the incidence of end-stage renal disease and its risk factors in Japanese patients with immunoglobulin A nephropathy

AU - Tanaka, Shigeru

AU - Ninomiya, Toshiharu

AU - Katafuchi, Ritsuko

AU - Masutani, Kosuke

AU - Tsuchimoto, Akihiro

AU - Tokumoto, Masanori

AU - Hirakata, Hideki

AU - Ooboshi, Hiroaki

AU - Kitazono, Takanari

AU - Tsuruya, Kazuhiko

PY - 2018/6/1

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N2 - Background There are limited data on secular trends in the incidence of end-stage renal disease (ESRD) and frequencies of its risk factors or treatment modalities in patients with immunoglobulin A nephropathy (IgAN). Methods This study divided 1255 patients with IgAN into three groups according to the timing of renal biopsy: 1979-89 (n = 232), 1990-99 (n = 574) and 2000-10 (n = 449). The age-adjusted incidence rates, incidence rate ratios and 95% confidence intervals (CIs) for ESRD were calculated by the person-year method and compared using Poisson regression analysis. Results A total of 63 patients (5.0%) developed ESRD. The age-adjusted incidence of ESRD decreased significantly over time, i.e. 11.5 per 1000 person-years (95% CI 5.4-24.6) in 1979-89, 6.5 per 1000 person-years (95% CI 1.0-25.2) in 1990-99 and 4.2 per 1000 person-years (95% CI 1.0-17.7) in 2000-10. The proportions of patients with preserved renal function and acute-stage inflammatory histologic changes (i.e. endocapillary hypercellularity and extracapillary proliferation) at the timing of biopsy increased over time, as did the rates of prescriptions of renin-angiotensin system blockers and corticosteroids (all P for trend <0.05). The effect of acute inflammatory histologic lesions on renal prognosis was drastically reduced over time. Conclusions These findings suggest that early diagnosis in the acute inflammatory phase and subsequent aggressive treatment may have contributed to the significant downward trend in the incidence of ESRD in patients with IgAN over three decades.

AB - Background There are limited data on secular trends in the incidence of end-stage renal disease (ESRD) and frequencies of its risk factors or treatment modalities in patients with immunoglobulin A nephropathy (IgAN). Methods This study divided 1255 patients with IgAN into three groups according to the timing of renal biopsy: 1979-89 (n = 232), 1990-99 (n = 574) and 2000-10 (n = 449). The age-adjusted incidence rates, incidence rate ratios and 95% confidence intervals (CIs) for ESRD were calculated by the person-year method and compared using Poisson regression analysis. Results A total of 63 patients (5.0%) developed ESRD. The age-adjusted incidence of ESRD decreased significantly over time, i.e. 11.5 per 1000 person-years (95% CI 5.4-24.6) in 1979-89, 6.5 per 1000 person-years (95% CI 1.0-25.2) in 1990-99 and 4.2 per 1000 person-years (95% CI 1.0-17.7) in 2000-10. The proportions of patients with preserved renal function and acute-stage inflammatory histologic changes (i.e. endocapillary hypercellularity and extracapillary proliferation) at the timing of biopsy increased over time, as did the rates of prescriptions of renin-angiotensin system blockers and corticosteroids (all P for trend <0.05). The effect of acute inflammatory histologic lesions on renal prognosis was drastically reduced over time. Conclusions These findings suggest that early diagnosis in the acute inflammatory phase and subsequent aggressive treatment may have contributed to the significant downward trend in the incidence of ESRD in patients with IgAN over three decades.

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U2 - 10.1093/ndt/gfx223

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