Sy-Go Janina Paula T, Moubarak Simon, Vaughan Lisa E, Klomjit Nattawat, Viehman Jason K, Fervenza F C, Zand Ladan
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota.
Department of Quantitative Health Sciences, Clinical Trials, and Biostatistics, Mayo Clinic, Rochester, Minnesota.
Clin J Am Soc Nephrol. 2024 Mar 1;19(3):319-328. doi: 10.2215/CJN.0000000000000358. Epub 2023 Nov 10.
Little is known about the prognostic significance of monoclonal gammopathy of undetermined and renal significance (MGUS and MGRS) in patients with CKD. The objective of this study was to determine the clinical and kidney outcomes of patients with CKD with either MGUS or MGRS compared with those with CKD without MGUS or MGRS.
We conducted a retrospective cohort study from 2013 to 2018. Patients who had both CKD diagnosis and monoclonal testing were identified. Patients were divided into MGRS, MGUS, and no monoclonal gammopathy groups. Cumulative incidence functions and Cox proportional hazards regression were used to model time to event data and to evaluate the association between monoclonal gammopathy status and risk of kidney failure, with death treated as a competing risk.
Among 1535 patients, 59 (4%) had MGRS, 648 (42%) had MGUS, and 828 (54%) had no monoclonal gammopathy. Unadjusted analysis showed that compared with no monoclonal gammopathy patients, patients with MGRS were at higher risk of kidney failure (hazard ratio [HR] [95% confidence interval]: 2.5 [1.5 to 4.2] but not patients with MGUS (HR [95% confidence interval]: 1.3 [0.97 to 1.6]), after taking death into account as a competing risk. However, in the multivariable analysis, after adjusting for age, sex, eGFR, proteinuria, and Charlson Comorbidity Index, the risk of progression to kidney failure (with death as competing risk) in the MGRS group was no longer statistically significant (HR: 0.9 [0.5 to 1.8]). The same was also true for the MGUS group compared with the group with no monoclonal gammopathy (HR: 1.3 [0.95 to 1.6]). When evaluating the association between MGUS/MGRS status and overall survival, MGRS was significantly associated with mortality in fully adjusted models compared with the group with no monoclonal gammopathy, while MGUS was not.
After adjusting for traditional risk factors, MGUS/MGRS status was not associated with a greater risk of kidney failure, but MGRS was associated with a higher risk of mortality compared with patients with no monoclonal gammopathy.
关于未确定意义的单克隆丙种球蛋白病（MGUS）和具有肾脏意义的单克隆丙种球蛋白病（MGRS）在慢性肾脏病（CKD）患者中的预后意义，人们了解甚少。本研究的目的是确定患有MGUS或MGRS的CKD患者与未患MGUS或MGRS的CKD患者的临床和肾脏结局。
我们进行了一项2013年至2018年的回顾性队列研究。确定了同时有CKD诊断和单克隆检测的患者。患者被分为MGRS组、MGUS组和无单克隆丙种球蛋白病组。累积发病率函数和Cox比例风险回归用于对事件发生时间数据进行建模，并评估单克隆丙种球蛋白病状态与肾衰竭风险之间的关联，将死亡视为竞争风险。
在1535例患者中，59例（4%）患有MGRS，648例（42%）患有MGUS，828例（54%）无单克隆丙种球蛋白病。未调整分析显示，与无单克隆丙种球蛋白病的患者相比，将死亡作为竞争风险考虑在内后，MGRS患者发生肾衰竭的风险更高（风险比[HR][95%置信区间]：2.5[1.5至4.2]），但MGUS患者并非如此（HR[95%置信区间]：1.3[0.97至1.6]）。然而，在多变量分析中，在调整年龄、性别、估算肾小球滤过率（eGFR）、蛋白尿和Charlson合并症指数后，MGRS组进展为肾衰竭的风险（将死亡作为竞争风险）不再具有统计学意义（HR：0.9[0.5至1.8]）。与无单克隆丙种球蛋白病组相比，MGUS组也是如此（HR：1.3[0.95至1.6]）。在评估MGUS/MGRS状态与总生存之间的关联时，在完全调整模型中，与无单克隆丙种球蛋白病组相比，MGRS与死亡率显著相关，而MGUS则不然。
在调整传统风险因素后，MGUS/MGRS状态与肾衰竭风险增加无关，但与无单克隆丙种球蛋白病的患者相比，MGRS与更高的死亡风险相关。
