Patients who have end-stage renal disease (ESRD) secondary to membranous nephropathy (MN) have superior survival on dialysis or following renal transplantation compared with patients whose ESRD is due to other causes, according to a recent study.

In addition, compared with patients who had other forms of glomerulonephritis (GN), those with MN have comparable dialysis and kidney transplant outcomes, except for higher death-censored graft failure and disease recurrence rates.

These findings should be used to better inform shared decision-making by clinicians and patients with MN regarding ESRD care, Wen-ling Yang, MD, of Peking University Third Hospital in Beijing, China, and Princess Alexandra Hospital in Brisbane, Australia, and colleagues concluded in a report in PLOS ONE.

In a study of 32,788 adult patients with ESRD starting renal replacement therapy (RRT) in Australia and New Zealand, the investigators found that patients with MN had a significant 21% decreased risk of death on dialysis and 43% decreased risk of death following kidney transplantation, in adjusted analyses, compared with patients who had other causes of ESRD,. The investigators found that the likelihood of survival among patients with MN was comparable to that of patients with other forms of GN.

Among patients on dialysis, the adjusted patient survival rates at 1, 5, and 10 years were 98%, 81%, and 58%, respectively, for patients with MN compared with 93%, 65%, and 36%, respectively, for patients with other causes of ESRD.

Among patients who receive kidney transplants, the patients with MN had a significant 55% and 57% increased risk of death-censored allograft failure compared with patients who had other ESRD causes and those with other forms of GN, respectively, in adjusted analyses.

In addition, among patients who started RRT on dialysis, 138 patients (36%) with MN underwent kidney transplantation compared with 6907 patients (22%) with ESRD from other causes, according to the investigators. In adjusted analyses, the MN group had a significant 38% greater likelihood of receiving a kidney transplant.

Among patients who received kidney transplants, the patients with MN had a significant 55% and 57% increased risk of death-censored allograft failure compared with patients who had other ESRD causes and those with other forms of GN, respectively, in adjusted analyses. Further, 11.4% of MN patients experienced primary disease recurrence in their allografts compared with 2.2% of patients with other causes of ESRD and 4.5% of patients with other forms of GN. In adjusted analyses, patients with MN had a significant 4.9-fold increased risk of primary disease recurrence compared with patients compared with patients who had ESRD from other causes and 2.8-fold increased risk compared with those who had other forms of GN, respectively.

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The study found no significant difference in the median time from dialysis initiation to first kidney transplant.

Of the 32,788 patients included in the study, 417 (1.3%) had MN as the cause of ESRD. Dialysis and kidney transplantation were the initial RRT for 31,767 and 1021 patients, respectively. Dialysis was the initial RRT for 338 patients with MN and 31,379 patients with ESRD from other causes. 

Reference

Yang WL, Bose B, Zhang L, et al. Long-term outcomes of patients with end-stage kidney disease due to membranous nephropathy: A cohort study using the Australia and New Zealand Dialysis and Transplant Registry [published online August 23, 2019]. PLoS One. 2019;14(8):e0221531. doi: 10.1371/journal.pone.0221531