Tanaka Shigeru, Ninomiya Toshiharu, Katafuchi Ritsuko, Masutani Kosuke, Nagata Masaharu, Tsuchimoto Akihiro, Hirakata Hideki, Kitazono Takanari, Tsuruya Kazuhiko
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Division of Research Management, Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Clin Exp Nephrol. 2016 Oct;20(5):689-698. doi: 10.1007/s10157-015-1195-y. Epub 2015 Nov 12.
The impact of renin-angiotensin system blockade (RASB) on the incidence of end-stage renal disease (ESRD) remains unclear in IgA nephropathy (IgAN).
This study assessed associations between RASB treatment and the incidence of ESRD in IgAN using propensity score approaches. We retrospectively analyzed 1273 patients with IgAN biopsied between 1979 and 2010. Propensity scores were calculated using logistic regression. Associations between RASB and ESRD were examined using a Cox regression model adjusted by inverse probability of treatment weighted, regression, stratification and matching.
During follow-up (median 5.1 years), 130 patients developed ESRD. With Cox regression adjusted by inverse probability of treatment weighted, RASB use was significantly associated with a lower risk of ESRD (hazard ratio 0.58; 95 % confidence interval 0.42-0.80). Significant associations were observed for other propensity score-based approaches. In stratified analysis, a beneficial association between RASB and ESRD was observed in patients ≥35 years, with hypertension, reduced estimated glomerular filtration rate (<60 mL/min/1.73 m), mesangial proliferation and segmental glomerulosclerosis (P for interaction <0.05), and tended to be greater in patients with proteinuria (≥1.0 g/24 h), extracapillary proliferation and receiving methylprednisolone pulse therapy (P for interaction <0.10).
Treatment with RASB was associated with a lower incidence of ESRD in the real-world practice of IgAN.
在IgA肾病（IgAN）中，肾素-血管紧张素系统阻断（RASB）对终末期肾病（ESRD）发生率的影响仍不明确。
本研究采用倾向评分法评估RASB治疗与IgAN患者ESRD发生率之间的关联。我们回顾性分析了1979年至2010年间接受活检的1273例IgAN患者。使用逻辑回归计算倾向评分。采用逆概率加权、回归、分层和匹配调整的Cox回归模型检验RASB与ESRD之间的关联。
在随访期间（中位时间5.1年），130例患者发展为ESRD。经逆概率加权调整的Cox回归分析显示，使用RASB与ESRD风险较低显著相关（风险比0.58；95%置信区间0.42 - 0.80）。其他基于倾向评分的方法也观察到显著关联。在分层分析中，年龄≥35岁、患有高血压、估计肾小球滤过率降低（<60 mL/min/1.73 m²）、系膜增生和节段性肾小球硬化的患者中，RASB与ESRD之间存在有益关联（交互作用P<0.05），蛋白尿（≥1.0 g/24 h）、毛细血管外增生和接受甲泼尼龙冲击治疗的患者中这种关联更明显（交互作用P<0.10）。
在IgAN的实际临床实践中，RASB治疗与ESRD的较低发生率相关。
