How do different GN types do on ESRD? A recent USRDS analysis looked at this very question.
1. Over 84,000 patients were found to have GN that were on ESRD In the time period reviewed
2. Interestingly IgA nephropathy had the fewest other comorbidities and the lowest use of hemodialysis
3. Crude mortality was also lowest in IgA nephropathy patients
4. Highest mortality was in Lupus nephritis and diabetic nephropathy patients when compared to IgAN
5. Patients with ADPKD had a relatively favorable comorbidity and laboratory profile, comparable with that in IgAN.
6. Overall, LN patients did the worst of all GNs.
7. Cardiovascular disease accounted for the highest proportion of deaths within all GN subtypes, ranging from 34.2% in vasculitis to 44.6% in FSGS.
8. The highest proportion of infection-related deaths was observed in LN
9. There were marked survival discrepancies that persisted even after adjustment for socio demographic and clinical factors.
10. Some GN subtypes (e.g., IgAN) conferred a particularly favorable prognosis, superior to that in ADPKD as stated above but, LN displayed shortened survival, similar to in patients with ESRD caused by diabetes.
These are some very important findings of the study. Categorizing GNs as on major cause of ESRD might be not helping us figure out the long term outcomes. As expected IgA and ADPKD have better survivals and some of the autoimmune and immunosuppressive prone GNs had worse outcomes.