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@article{Canney:2021:10.1681/ASN.2020030349,
author = {Canney, M and Barbour, SJ and Zheng, Y and Coppo, R and Zhang, H and Liu, Z-H and Matsuzaki, K and Suzuki, Y and Katafuchi, R and Reich, HN and Cattran, D and International, IgA Nephropathy Network and International, IgA Nephropathy Network Investigators},
doi = {10.1681/ASN.2020030349},
journal = {J Am Soc Nephrol},
pages = {436--447},
title = {Quantifying Duration of Proteinuria Remission and Association with Clinical Outcome in IgA Nephropathy.},
url = {http://dx.doi.org/10.1681/ASN.2020030349},
volume = {32},
year = {2021}
}

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TY  - JOUR
AB  - BACKGROUND: On the basis of findings of observational studies and a meta-analysis, proteinuria reduction has been proposed as a surrogate outcome in IgA nephropathy. How long a reduction in proteinuria needs to be maintained to mitigate the long-term risk of disease progression is unknown. METHODS: In this retrospective multiethnic cohort of adult patients with IgA nephropathy, we defined proteinuria remission as a ≥25% reduction in proteinuria from the peak value after biopsy, and an absolute reduction in proteinuria to <1 g/d. The exposure of interest was the total duration of first remission, treated as a time-varying covariate using longitudinal proteinuria measurements. We used time-dependent Cox proportional hazards regression models to quantify the association between the duration of remission and the primary outcome (ESKD or a 50% reduction in eGFR). RESULTS: During a median follow-up of 3.9 years, 274 of 1864 patients (14.7%) experienced the primary outcome. The relationship between duration of proteinuria remission and outcome was nonlinear. Each 3 months in sustained remission up to approximately 4 years was associated with an additional 9% reduction in the risk of disease progression (hazard ratio [HR], 0.91; 95% confidence interval [95% CI], 0.89 to 0.93). Thereafter, each additional 3 months in remission was associated with a smaller, nonsignificant risk reduction (HR, 0.99; 95% CI, 0.96 to 1.03). These findings were robust to multivariable adjustment and consistent across clinical and histologic subgroups. CONCLUSIONS: Our findings support the use of proteinuria as a surrogate outcome in IgA nephropathy, but additionally demonstrate the value of quantifying the duration of proteinuria remission when estimating the risk of hard clinical endpoints.
AU  - Canney,M
AU  - Barbour,SJ
AU  - Zheng,Y
AU  - Coppo,R
AU  - Zhang,H
AU  - Liu,Z-H
AU  - Matsuzaki,K
AU  - Suzuki,Y
AU  - Katafuchi,R
AU  - Reich,HN
AU  - Cattran,D
AU  - International,IgA Nephropathy Network
AU  - International,IgA Nephropathy Network Investigators
DO  - 10.1681/ASN.2020030349
EP  - 447
PY  - 2021///
SP  - 436
TI  - Quantifying Duration of Proteinuria Remission and Association with Clinical Outcome in IgA Nephropathy.
T2  - J Am Soc Nephrol
UR  - http://dx.doi.org/10.1681/ASN.2020030349
UR  - https://www.ncbi.nlm.nih.gov/pubmed/33514642
VL  - 32
ER  -

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