Serum Albumin at Partial Remission Predicts Outcomes in Membranous Nephropathy

Taewoo Lee, Yunro Chung, Caroline J. Poulton, Vimal K. Derebail, Susan L. Hogan, Heather N. Reich, Ronald J. Falk, Patrick H. Nachman

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: In primary membranous nephropathy (MN), partial remission (PR) (≥50% reduction of proteinuria to <3.5 g/d) is associated with a greater risk of relapse and end-stage kidney disease (ESKD) compared with complete remission (CR). We aimed to determine factors associated with relapse or renal failure in patients who attain the standard definition of PR. Methods: We captured PR, CR, relapse, and the composite of doubling of serum creatinine or ESKD in a cohort of 267 patients with MN, nephrotic syndrome, and >12 months of follow-up. Characteristics at the time of PR associated with the composite outcome or relapse were evaluated using a time-to-event analysis. Results: A total of 192 patients attained PR and 86 attained CR. Serum albumin at PR (hazard ratio [HR]: 1.58 per 0.5 g/dl decrease from 4.0 g/dl; 95% confidence interval [CI]: 1.03–2.43) and duration of nephrotic proteinuria (HR: 1.01 per month increase; 95% CI: 1.00–1.03) were independent risk factors for the composite endpoint. Serum albumin at PR was associated with an increased risk of relapse (HR: 1.58 per 0.5 g/dl decrease below 4.0 g/dl; 95% CI: 1.24–2.01). A cutoff for serum albumin ≤3.5 g/dl at PR performed best in predicting relapse and composite outcome. Conclusions: Patients with serum albumin >3.5 g/dl at PR have decreased risk of composite outcome or relapse compared with PR with low albumin. A definition of PR that includes normalization of serum albumin may be a more robust surrogate endpoint in MN than the traditional definition of PR.

Original languageEnglish (US)
Pages (from-to)706-717
Number of pages12
JournalKidney International Reports
Volume5
Issue number5
DOIs
StatePublished - May 2020

Bibliographical note

Funding Information:
This work was supported by the University of North Carolina Kidney Center.

Funding Information:
National Institutes of Health (NIH): VKD, SLH, CJP, RJF, and PHN; NIH, NephCure Kidney International, and University of Michigan via the Nephrotic Syndrome Study Network Consortium (NEPTUNE): VKD, PHN, and HNR; Food and Drug Administration: VKD and PHN; Kidney Foundation of Canada and Canadian Institutes of Health Research Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE) Network: HNR; RTI International: VKD; and honoraria from the American Society of Nephrology: PHN and HNR. HNR holds the University of Toronto Gabor Zellerman Chair in Nephrology Research. RJF is the Nan and Hugh Cullman Eminent Professor of Medicine.

Publisher Copyright:
© 2020 International Society of Nephrology

Keywords

  • albuminemia
  • membranous nephropathy
  • nephrotic syndrome
  • proteinuria
  • remission
  • surrogate endpoint

PubMed: MeSH publication types

  • Journal Article

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