University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
Dr. Carol Davila Teaching Hospital of Nephrology, Bucharest, Romania.
Medicine (Baltimore). 2022 Sep 9;101(36):e30422. doi: 10.1097/MD.0000000000030422.
The use of immunosuppressive therapy for immunoglobulin A nephropathy (IgAN) patients with stage 3 or 4 chronic kidney disease (CKD) is controversial. We performed a monocentric retrospective study on 83 consecutive IgAN patients with stage 3 or 4 CKD and proteinuria ≥0.75 g/d (age 41 [33-56] years, 72% male, estimated glomerular filtration rate 36.1 [25.4-47.5] mL/min/1.73 m2) who received uncontrolled supportive care (Supp) (n = 36), corticosteroids/corticotherapy (CS) (n = 14), or CS combined with monthly pulses of cyclophosphamide (CS + CFM) (n = 33) between 2010 and 2017. Patients were followed until composite endpoint (doubling of serum creatinine, end-stage kidney disease (dialysis or kidney transplant) or death, whichever came first) or end of study (January 2020). Patients were followed for a median of 29 (95% confidence interval = 25.2-32.7) months, and 12 (15%) patients experienced the composite endpoint. Within the limitation of a retrospective study, our results suggest no benefit from immunosuppressive therapy in patients with IgAN with stage 3 and 4 CKD as compared with supportive care. There were no differences between the 3 studied groups regarding age, estimated glomerular filtration rate, proteinuria, Oxford classification score, arterial hypertension, and therapy with renin-angiotensin system inhibitors. Mean kidney survival time for the entire cohort was 81.0 (95% confidence interval = 73.1-89.0) months, without significant differences between the 3 groups. In univariate and multivariate Cox regression analysis adjusted for IgAN progression factors, immunosuppressive therapy was not associated with better kidney survival when compared with supportive therapy.
对于患有 3 或 4 期慢性肾脏病 (CKD) 和蛋白尿≥0.75 g/d（年龄 41 [33-56] 岁，72%为男性，估算肾小球滤过率 36.1 [25.4-47.5] mL/min/1.73 m2）的 IgA 肾病 (IgAN) 患者，使用免疫抑制疗法存在争议。我们对 2010 年至 2017 年间连续 83 例患有 3 或 4 期 CKD 和蛋白尿≥0.75 g/d（年龄 41 [33-56] 岁，72%为男性，估算肾小球滤过率 36.1 [25.4-47.5] mL/min/1.73 m2）的 IgAN 患者进行了一项单中心回顾性研究，这些患者接受了未受控制的支持性治疗（Supp）（n = 36）、皮质类固醇/皮质激素治疗（CS）（n = 14）或 CS 联合每月环磷酰胺脉冲治疗（CS + CFM）（n = 33）。患者在随访期间出现复合终点（血清肌酐加倍、终末期肾病（透析或肾移植）或死亡，以先发生者为准）或研究结束（2020 年 1 月）。患者中位随访时间为 29（95%置信区间 = 25.2-32.7）个月，12（15%）例患者出现复合终点。在回顾性研究的限制内，我们的结果表明，与支持性治疗相比，免疫抑制疗法对 IgAN 合并 3 或 4 期 CKD 患者没有获益。在年龄、估算肾小球滤过率、蛋白尿、牛津分类评分、动脉高血压和肾素-血管紧张素系统抑制剂治疗方面，3 个研究组之间没有差异。整个队列的平均肾脏生存时间为 81.0（95%置信区间 = 73.1-89.0）个月，3 组之间无显著差异。在调整了 IgAN 进展因素的单变量和多变量 Cox 回归分析中，与支持性治疗相比，免疫抑制治疗与更好的肾脏生存无关。
