The outcomes of patients with kidney failure due to focal segmental glomerulosclerosis (FSGS) in Australia and New Zealand: A cohort study using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA)

• Published in: PloS one Vol. 18; no. 11; p. e0293721
• Main Authors: Bose, Bhadran, Milanzi, Elasma, Pascoe, Elaine M., Johnson, David W., Badve, Sunil V.
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 02.11.2023; Public Library of Science (PLoS)
• Subjects: Allografts; Biology and Life Sciences; Body mass index; Cardiovascular disease; Coronary vessels; Death; Diabetes; Dialysis; Failure; Health risks; Hemodialysis; Kidney diseases; Kidney transplantation; Kidney transplants; Lung diseases; Medicine and Health Sciences; Mortality; Patients; Renal failure; Renal replacement therapy; Risk assessment; Statistical analysis; Survival; New Zealand; Australia
• DOI: 10.1371/journal.pone.0293721
• ISSN: 1932-6203

BackgroundThe outcomes of patients with focal segmental glomerulosclerosis (FSGS) on kidney replacement therapy (KRT) have not been well described. This study evaluated the outcomes of patients with kidney failure due to FSGS on KRT including dialysis and kidney transplantation.Method and materialsAll adult patients with kidney failure who commenced KRT in Australia and New Zealand from 15th of May 1963 to 31st of December 2018 were retrospectively extracted from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Outcomes of patients with FSGS were compared to those with other causes of kidney failure (non-FSGS).Results85,052 patients commenced KRT during the study period, of whom 2991 (3.5%) were patients with FSGS. Compared to patients with non-FSGS, patients with FSGS experienced similar mortality on dialysis (adjusted hazard ratio [aHR] 0.98, 95% CI 0.90–1.06, p = 0.55) and following kidney transplantation (aHR 0.92, 95% CI 0.73–1.15, p = 0.47). The risk of first kidney allograft loss was higher in patients with FSGS (aHR 1.20, 95% CI 1.04–1.37, p = 0.01). However, when death was analysed as a competing risk, the survival in both groups was similar (sub-hazard ratio [SHR] 1.09, 95% CI 0.94–1.28, p = 0.26). Patients with FSGS had a longer waiting time for kidney transplantation (aHR 0.92, 95% CI 0.86–0.98, p = 0.02) and experienced an increased risk of disease recurrence in the allograft (aHR 1.73, 95% CI 1.35–2.21, p<0.001). Compared to patients with other forms of glomerular disease, patients with FSGS experienced similar dialysis and transplant patient survival and death-censored rate of kidney transplantation and allograft loss but higher rates of primary kidney disease recurrence.ConclusionFSGS was associated with similar dialysis and transplant patient survival and death-censored first allograft loss compared to non-FSGS and other forms of glomerular disease.