Long-term renal survival and related risk factors in patients with IgA nephropathy: results from a cohort of 1155 cases in a Chinese adult population

Background. We sought to identify the long-term renal survival rate and related risk factors of progression to renal failure in Chinese adult patients with IgA nephropathy (IgAN) and to quantify the effects of proteinuria during the follow-up on outcome in patients with IgAN. Methods. Patients with biopsy-proven primary IgAN in the Nanjing Glomerulonephritis Registry were studied. Renal survival and the relationships between clinical parameters and renal outcomes were assessed. Results. One thousand one hundred and fifty-five patients were enrolled in this study. The 10-, 15- and 20-year cumulative renal survival rates, calculated by Kaplan-Meier method, were 83, 74 and 64%, respectively. At the time of biopsy, proteinuria >1.0 g/day [hazard ratio (HR) 3.2, P < 0.001], estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m(2) (HR 2.6, P < 0.001), hypertension (HR 1.9, P < 0.001), hypoproteinemia (HR 2.0, P < 0.001) and hyperuricemia (HR 2.1, P < 0.001) were the independent risk factors. Multivariate Cox analysis showed the time-average proteinuria (TA-P) during follow-up was the most important risk factor of renal failure. Patients with TA-P >1.0 g/day were associated with a 9.4-fold risk than patients with TA-P <1.0 g/day (P < 0.001) and 46.5-fold risk than those with TA-P <0.5 g/day (P < 0.001). Moreover, patients who achieved TA-P <0.5 g/day benefit much more than those with TA-P between 0.5 and 1.0 g/day (HR 13.1, P < 0.001). Conclusions. Thirty-six percent of Chinese adult patients with IgAN progress to end stage renal disease within 20 years. Five clinical features-higher proteinuria, hypertension, impaired renal function, hypoproteinemia and hyperuricemia-are independent predictors of an unfavorable renal outcome. The basic goal of anti-proteinuric therapy for Chinese patients is to lower proteinuria <1.0 g/day and the optimal goal is to lower proteinuria to <0.5 g/day.