Here we conducted a retrospective study to examine the risk of cardiovascular events (CVEs) relative to that of end-stage renal disease (ESRD) in patients with primary membranous nephropathy, in a discovery cohort of 404 patients. The cumulative incidence of CVEs was estimated in the setting of the competing risk of ESRD with risk factors for CVEs assessed by multivariable survival analysis. The observed cumulative incidences of CVEs were 4.4%, 5.4%, 8.2%, and 8.8% at 1, 2, 3, and 5 years respectively in the primary membranous nephropathy cohort. In the first 2 years after diagnosis, the risk for CVEs was similar to that of ESRD in the entire cohort, but exceeded it among patients with preserved renal function. Accounting for traditional risk factors and renal function, the severity of nephrosis at the time of the event (hazard ratio 2.1, 95% confidence interval 1.1 to 4.3) was a significant independent risk factor of CVEs. The incidence and risk factors of CVEs were affirmed in an external validation cohort of 557 patients with primary membranous nephropathy. Thus early in the course of disease, patients with primary membranous nephropathy have an increased risk of CVEs commensurate to, or exceeding that of ESRD. Hence, reduction of CVEs should be considered as a therapeutic outcome measure and focus of intervention in primary membranous nephropathy.
Bibliographical noteFunding Information:
We are indebted to the contribution of the nephrologists of the Greater Toronto Area and of the Glomerular Disease Collaborative Network. This work would not be possible without the contribution of registrars N. Ryan, P. Lam, and P. Ling. TL was supported by the UNC Kidney Center. VKD was supported by the NephCure Foundation, Nephrotic Syndrome Study Network Career Development Award (U-54-DK-083912). Investigator-initiated support from Amgen Canada contributed to support of the TGNR. HNR's work is supported by the Gabor Zellerman Chair in Nephrology Research.
- cardiovascular disease
- membranous nephropathy