The following is a summary of “Kidney sequelae in 281 Shiga toxin–producing Escherichia coli-hemolytic uremic syndrome patients after a median follow-up of 12 years,” published in the October 2023 issue of Nephrology by Alconcher et al.
Many patients with Escherichia coli-hemolytic uremic syndrome (STEC-HUS) develop chronic kidney disease (CKD). Researchers started a retrospective study to assess long-term renal outcomes and identify CKD predictors in STEC-HUS patients.
They analyzed long-term outcomes of patients based on the presence of complete recovery (CR) or CKD at their last visit. The patients were categorized into favorable outcomes (CR + CKD1) or poor outcomes (CKD2–5), and predictors at the time of diagnosis (sex, age, leukocytes, creatinine, hemoglobin, and HUS severity score), along with dialysis duration and follow-up time, were compared between these two groups.
The results showed 281 patients, followed for a median of 12 years, 139 (49%) achieved CR, 104 (37%) had CKD1, 27 (10%) had CKD2–4, and 11 (4%) had CKD5. About 38 patients progressed to CKD2–5 after a median of 4.8 years, with 7% within the first 5 years, increasing to 8%, 10%, and 14% after 5–10 years, 10–15 years, and > 15 years. This subgroup was characterized by younger age, higher baseline hemoglobin, elevated leukocyte count, and longer dialysis and follow-up periods compared to those with a favorable outcome. Multivariate analysis pinpointed dialysis days and follow-up duration as independent predictors of poor results, with an optimal dialysis duration cutoff at 10 days. Five years later, 20% of those dialyzed for ≥ 10 days developed CKD2–5, while only 1% of those not dialyzed or dialyzed for < 10 days did.
They concluded that half of STEC-HUS patients developed CKD after 12 years, including 14% with CKD2-5.