Long-Term Outcomes in Nephrotic Syndrome by Kidney Biopsy Diagnosis and Proteinuria
Journal of the American Society of Nephrology – 2025
Kidney Failure Attributed to Focal Segmental Glomerulosclerosis: A USRDS Retrospective Cohort Study of Epidemiology, Treatment Modalities, and Economic Burden
Journal article
Published on November 27, 2023
Contributors:
Bensink ME, Goldschmidt D, Zhou Z-Y et al.
Bensink ME, Goldschmidt D, Zhou Z-Y et al.
DOI:
10.1016/j.xkme.2023.100760
10.1016/j.xkme.2023.100760
Summary
Kidney failure due to focal segmental glomerulosclerosis (FSGS) imposes a high clinical and economic burden in the US1
Background
Focal segmental glomerulosclerosis (FSGS) can be caused by a variety of factors such as genetics, drugs, or infections.1-3 FSGS accounts for approximately 35% of all nephrotic syndrome cases.1-3 The incidence of FSGS in the US from 2004 to 2013 was 3.2 per 100,000 person-years, a 41% increase over the previous decade.1,4 The goal of therapy is reduction or remission of proteinuria, as there is no cure.1,5 Up to half of patients progress to kidney failure within 5 to 10 years, resulting in a need for dialysis or transplantation that places a substantial burden on the healthcare system.1,6,7 Despite this high burden, there is limited real-world data about FSGS in the US.1
Aim
This study used data from the US Renal Data System (USRDS) to assess the epidemiology, characteristics, treatment patterns, and outcomes of patients with FSGS kidney failure.1
Approach
A retrospective cohort analysis identified all patients with kidney failure due to FSGS in the USRDS, a national database covering all patients with kidney failure, from 2008 to 2018.1 Data on patient demographics, treatment patterns, and clinical outcomes were summarized.1 Index date was the first registration of data, and patients were followed until death, loss to follow-up, or data end.1
Data on healthcare resource usage and costs were assessed in a subgroup of patients with ≥1 year of continuous Medicare coverage.1
Findings
Prevalence and incidence
From 2008 to 2018, the mean annual period prevalence and incidence of kidney failure due to FSGS in the US were 87.6 and 7.5 per million, respectively.1 Prevalence per million increased from 76.5 in 2008 to 96.0 in 2018.1
Baseline demographics
- Overall cohort: 25,699 (including 5,575 in the Medicare cohort)1
- Mean (standard deviation [SD]) age at USRDS registration1:
- Overall: 51.0 (18.9) years
- Medicare subgroup: 63.0 (17.2) years
- Proportion male: 61.4%1
- Most common comorbid conditions1:
- Hypertension (87.7%)
- Diabetes (17.9%)
Treatment and clinical outcomes
In the overall cohort:
- Mean follow-up time: 54.4 months1
- Common treatment modalities at registration1:
- In-center hemodialysis (72.1%)
- Peritoneal dialysis (20.2%)
One-third of patients received a kidney transplant during the study period1
In total, 7.3% of patients received a kidney transplant as their initial treatment.1 This increased to 14.7% by one year after index date and 33.0% over the entire study period.1 Median time to transplant was 7.2 years.1
Healthcare resource utilization and economic burden was high1
In the Medicare subgroup, 76.6% had an inpatient admission, and among hospitalized patients, the average stay was 3.8 days per patient per month.1 In this subgroup, the mean annual total healthcare costs were $68,384.1
Key takeaway
Kidney failure due to FSGS imposes a high clinical and economic burden on both patients and healthcare systems.1 Therapies for kidney failure, like dialysis and transplant, contribute to a high economic burden for patients.1 These data suggest that novel treatments that slow progression to kidney failure are needed to reduce this burden.1
Related Content
Long-Term Outcomes in Nephrotic Syndrome by Kidney Biopsy Diagnosis and Proteinuria
Journal of the American Society of Nephrology – 2025
Population Risk Predictors of Major Adverse Kidney Events Attributed to FSGS from the CURE-CKD Registry
BMC Nephrology – 2025
Efficacy and Safety of ACE Inhibitor and Angiotensin Receptor Blocker Therapies in Primary Focal Segmental Glomerulosclerosis Treatment: A Systematic Review and Meta-Analysis
Kidney Medicine – 2022
Footnotes
This work was supported by Travere Therapeutics, Inc. Please see the publication for the full list of disclosures.
FSGS, focal segmental glomerulosclerosis; SD, standard deviation; US, United States; USRDS, US Renal Data System.
- Bensink ME et al. Kidney Med. 2023;6(2):100760.
- Haas M et al. Am J Kidney Dis. 1997;30(5):621-631.
- Rosenberg AZ, Kopp JB. Clin J Am Soc Nephrol. 2017;12(3):502-517.
- Hommos MS et al. Mayo Clin Proc. 2017;92(12):1772-1781.
- Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. Kidney Int. 2021;100(4S):S1-S276.
- Moranne O et al. QJM. 2008;101(3):215-224.
- Kalantar-Zadeh K et al. Kidney Int Rep. 2021;6(10):2679-2688.
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