title: Long-term outcomes of end-stage kidney disease for patients with IgA nephropathy: A multi-centre registry study.
abstract: BACKGROUND
  Clinical outcomes of patients with end-stage kidney disease (ESKD) receiving renal replacement therapy (RRT) secondary to IgA nephropathy (IgAN) have not been well described.
  
  
  OBJECTIVE
  To investigate the characteristics, treatments and outcomes of ESKD because of kidney-limited IgAN and Henoch-Schönlein purpura nephritis (HSPN) in the Australian and New Zealand RRT populations.
  
  
  METHODS
  All ESKD patients who commenced RRT in Australia and New Zealand between 1971 and 2012 were included. Dialysis and transplant outcomes were evaluated in both a contemporary cohort (1998-2012) and the entire cohort (1971-2012).
  
  
  RESULTS
  Of 63 297 ESKD patients, 3721 had kidney-limited IgAN, and 131 had HSPN. For the contemporary cohort of IgAN patients on dialysis (n = 2194), 10-year patient survival was 65%. Of 1368 contemporary IgAN patients who received their first renal allograft, 10-year patient, overall renal allograft and death-censored renal allograft survival were 93%, 82% and 88%, respectively. Using multivariable Cox regression analysis, patients with IgAN had favourable dialysis patient survival (adjusted hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.57-0.69), overall renal allograft survival (HR 0.67, 95% CI 0.57-0.79) and renal transplant patient survival (HR 0.58, 95% CI 0.45-0.74) compared with ESKD controls. Similar results were found in the entire cohort and when using competing-risks models. Compared with kidney-limited IgAN patients, those with HSPN had worse dialysis patient survival (HR 1.94, 95% CI 1.02-3.69), overall renal allograft survival (HR 3.40, 95% CI 1.00-11.55) and renal transplant patient survival (HR 3.50, 95% CI 1.03-11.92).
  
  
  CONCLUSIONS
  IgAN ESKD was associated with better dialysis and renal transplant outcomes compared with other forms of ESKD. The survival outcomes of ESKD patients with HSPN were worse than kidney-limited IgAN.
authors.affiliation: ANZDATA Registry, Adelaide, Australia.|Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.|Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.
authors.forename: Xusheng
authors.initials: X
authors.lastname: Liu
authors.affiliation: ANZDATA Registry, Adelaide, Australia.|Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Pascoe
authors.affiliation: ANZDATA Registry, Adelaide, Australia.|Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.|Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Badve
authors.affiliation: ANZDATA Registry, Adelaide, Australia.|School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, The University of Western Australia, Perth, Australia.
authors.forename: Neil C
authors.initials: NC
authors.lastname: Boudville
authors.affiliation: ANZDATA Registry, Adelaide, Australia.|Department of Nephrology, Prince of Wales Hospital, Sydney, Australia.|School of Public Health, University of Sydney, Sydney, Australia.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Clayton
authors.affiliation: Department of Renal Medicine, North Shore Hospital, Auckland, New Zealand.|The University of Auckland, Auckland, New Zealand.
authors.forename: Janak
authors.initials: J
authors.lastname: De Zoysa
authors.affiliation: ANZDATA Registry, Adelaide, Australia.|Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.|Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia.
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hawley
authors.affiliation: ANZDATA Registry, Adelaide, Australia.|Department of Nephrology, Monash Health and Department of Medicine, Melbourne, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Kanellis
authors.affiliation: ANZDATA Registry, Adelaide, Australia.|School of Medicine, University of Adelaide, Adelaide, Australia.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: McDonald
authors.affiliation: School of Medicine, University of Adelaide, Adelaide, Australia.
authors.forename: Chen Au
authors.initials: CA
authors.lastname: Peh
authors.affiliation: ANZDATA Registry, Adelaide, Australia.|Department of Nephrology, Monash Health and Department of Medicine, Melbourne, Australia.|School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Kevan R
authors.initials: KR
authors.lastname: Polkinghorne
authors.affiliation: ANZDATA Registry, Adelaide, Australia.|Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.|Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia.
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
mesh_terms: D001315:Australia / Q000453:epidemiology; D016009:Chi-Square Distribution; D018450:Disease Progression; D005922:Glomerulonephritis, IGA / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006085:Graft Survival; D006801:Humans; D011695:IgA Vasculitis / Q000175:diagnosis / Q000401:mortality; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D015999:Multivariate Analysis; D009520:New Zealand / Q000453:epidemiology; D016016:Proportional Hazards Models; D012042:Registries; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Henoch-Schönlein purpura; IgA nephropathy; dialysis; end-stage kidney disease; outcomes; renal transplantation