Tuttle Katherine R, Kornowske Lindsey M, Jones Cami R, Daratha Kenn B, Alicic Radica Z, Reynolds Christina L, Neumiller Joshua J, Bensink Mark E, Gong Wu, Norris Keith C, Nicholas Susanne B
Providence Medical Research Center, Providence Inland Northwest Health, Spokane, WA.
Kidney Research Institute and Institute of Translational Health Sciences, University of Washington, Seattle, WA.
Kidney Med. 2025 Feb 13;7(4):100981. doi: 10.1016/j.xkme.2025.100981. eCollection 2025 Apr.
RATIONALE & OBJECTIVE: Although IgA nephropathy (IgAN) therapies are advancing quickly, therapeutic interventions are hampered by a lack of kidney disease identification and risk assessment. The study aim was to use population-level data from health systems to identify IgAN and assess risks.
A longitudinal and real-world cohort study.
SETTING & PARTICIPANTS: Electronic health record data for patients ≥18 years old with IgAN at Providence and University of California Los Angeles health systems during 2016-2022.
Health insurance and care utilization along with age, gender, race, ethnicity, estimated glomerular filtration rate (eGFR), urine albumin/creatinine ratio (UACR) or urine protein/creatinine ratio (UPCR), diabetes, hypertension, and medications.
Time to first major adverse kidney event (MAKE): ≥40% eGFR decline; eGFR <15 mL/min/1.73 m2; administrative codes for kidney failure, dialysis, or transplant; and death.
Kaplan-Meier survival curves and Cox proportional hazards models.
Patients with IgAN (n = 2,571) were 50% (n = 1,277) women and 58 ± 18 (mean ± SD) years old. At baseline, eGFR was 78 ± 27 mL/min/1.73 m (chronic kidney disease epidemiologic 2021 equation); median UACR and UPCR were 166 (interquartile range 25-795) mg/g and 0.7 (0.2-1.8) g/g, respectively, among those with baseline measurements (n = 669). MAKE occurred in 22% of the cohort by 3 years. In Cox proportional hazards models, MAKE was predicted by noncommercial (Medicare or Medicaid) health insurance, hospitalization, more frequent outpatient encounters, lower eGFR, and a higher UACR or UPCR.
Missingness, miscoding, and retrospective data.
Substantial loss of kidney function, kidney failure, and death were common events over a short period of time in patients with IgAN. Within health system populations, noncommercial health insurance and greater care utilization augmented risk prediction and could help to identify those who may benefit from closer monitoring and implementation of therapeutic interventions.
尽管IgA肾病（IgAN）的治疗进展迅速，但由于缺乏肾脏疾病的识别和风险评估，治疗干预受到阻碍。本研究的目的是利用卫生系统的人群水平数据来识别IgAN并评估风险。
一项纵向的真实世界队列研究。
2016 - 2022年期间，普罗维登斯医疗系统和加利福尼亚大学洛杉矶分校医疗系统中年龄≥18岁的IgAN患者的电子健康记录数据。
医疗保险和医疗服务利用情况，以及年龄、性别、种族、民族、估计肾小球滤过率（eGFR）、尿白蛋白/肌酐比值（UACR）或尿蛋白/肌酐比值（UPCR）、糖尿病、高血压和用药情况。
首次发生重大不良肾脏事件（MAKE）的时间：eGFR下降≥40%；eGFR<15 mL/min/1.73 m²；肾衰竭、透析或移植的管理代码；以及死亡。
Kaplan-Meier生存曲线和Cox比例风险模型。
IgAN患者（n = 2571）中女性占50%（n = 1277），年龄为58±18（均值±标准差）岁。基线时，eGFR为78±27 mL/min/1.73 m²（采用2021年慢性肾脏病流行病学公式）；在有基线测量值的患者（n = 669）中，UACR和UPCR的中位数分别为166（四分位间距25 - 795）mg/g和0.7（0.2 - 1.8）g/g。3年内，22%的队列发生了MAKE。在Cox比例风险模型中，非商业（医疗保险或医疗补助）医疗保险、住院治疗、更频繁的门诊就诊、较低的eGFR以及较高的UACR或UPCR可预测MAKE的发生。
数据缺失、编码错误和回顾性数据。
在IgAN患者中，短期内肾功能严重丧失、肾衰竭和死亡是常见事件。在卫生系统人群中，非商业医疗保险和更高的医疗服务利用率增强了风险预测能力，有助于识别那些可能从密切监测和实施治疗干预中获益的患者。
