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Kidney Failure Attributed to Immunoglobulin A Nephropathy: A USRDS Retrospective Cohort Study of Epidemiology, Treatment Modalities, and Economic Burden

Journal article
Published on November 27, 2023

Topics: Nephrology IgAN HEOR Pharmacological RWE USRDS

Contributors:
Bensink M, Goldschmidt D, Zhou ZY et al.
Name of Journal:
Kidney Medicine


View Publication
DOI:
10.1016/j.xkme.2023.100759
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Home » Publications » USRDS Study: Kidney Failure in IgAN

Summary

Kidney failure due to IgA nephropathy is associated with high economic and clinical burdens for patients and the healthcare system1


Background

IgA nephropathy is a rare disease arising from damage to the glomerular filtration barrier by IgA-mediated inflammation.2,3 As the disease progresses patients develop3:

  • Proteinuria
  • Hematuria
  • Decreased kidney function

Eventually, 15 to 40% of patients progress to developing kidney failure due to IgA nephropathy.4 Disease progression is associated with greater patient and healthcare system burden.5

There is no cure for IgA nephropathy, but angiotensin-converting enzyme inhibitors (ACEis) and angiotensin II receptor blockers (ARBs) are recommended to control blood pressure and proteinuria.6

The lack of real-world evidence in the US on kidney failure due to IgA nephropathy is a barrier to addressing the unmet medical needs in this population.1


Aim

Using data from the US Renal Data System (USRDS) from 2008 to 2018, this study aimed to understand the epidemiology, characteristics, treatment patterns, and outcomes of patients with kidney failure due to IgA nephropathy.1


Approach

This was a retrospective cohort study of patients with kidney failure due to IgA nephropathy identified in the USRDS, a national database covering all patients with kidney failure.1 Data on patient demographics, treatment modalities, and clinical outcomes were summarized.1 Patients were followed from USRDS registration (index date) until loss to follow-up, data end, or death.1

Healthcare resource utilization and costs were evaluated by analyzing a subgroup analysis of patients with ≥1 year of continuous Medicare coverage.1


Findings

Prevalence and incidence

During the study, the mean annual period prevalence and incidence of IgA nephropathy kidney failure in the US population was 39.3 and 2.9 per million persons, respectively.1

Prevalence was higher among native Hawaiian/Pacific Islanders (380.5 per million), followed by Asians (107.1 per million).1

Baseline demographics

  • Overall cohort: 10,101 patients (including 1,696 in the Medicare Coverage subgroup)1
  • Mean (SD) age at USRDS registration:
    • Overall: 47.7 (15.9) years1
    • Medicare subgroup: 59.7 (17.1) years1
  • Proportion male:
    • Overall: 65.8%1
    • Medicare subgroup: 66.6%1
  • Most common comorbid conditions in both groups: Hypertension and diabetes1

Treatment modalities and clinical outcomes

In the overall cohort:

  • Mean follow-up time: 64.0 months1
  • Common treatment modalities at registration: In-center hemodialysis (63.1%) and peritoneal dialysis (21.5%)1

More than half of patients received a kidney transplant during follow-up1

15.1% of patients received a kidney transplant as their initial therapy, and by one year after the index date, this number had increased to 28.2% and up to 53.2% over the entire study period; the mean time to transplant was 3.8 years.1

Healthcare resource utilization and economic burden was high1

In the Medicare Coverage subgroup, 74.4% required in-patient admission within the first year, with an average stay of 3.6 days per patient per month.1 Among patients in this subgroup with ≥1 year coverage, estimated mean annual healthcare costs were $63,402.1


Key takeaway

Kidney failure due to IgA nephropathy imposes a great clinical and economic burden on patients and the healthcare system.1 These findings highlight the need for novel therapies that delay or prevent the need for dialysis and transplantation to improve outcomes and reduce the clinical burden.1






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Clinicopathological Characteristics of Adult IgA Nephropathy in the United States

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Footnotes


ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker; IgA, immunoglobulin A; US, United States; USRDS, US Renal Data System.

  1. Bensink ME et al. Kidney Med. 2023;6(2):100759.
  2. Wyatt RJ, Julian BA. N Engl J Med. 2013;368(25):2402-2414.
  3. Fabiano RCG et al. Inflam Res. 2016;65(10):757-770.
  4. Donadio JV, Grande JP. N Engl J Med. 2002;347(10):738-748.
  5. Kwon CS et al. J Health Econ Outcomes Res. 2021;8(2):36-45.
  6. Floege J et al. Sem Immunopathol. 2021;43(5):717-728.

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