Steroids reduce the risk for major adverse kidney outcomes in people with high-risk immunoglobulin A nephropathy (IgAN), but full-dose methylprednisolone increased the risk for serious adverse events, according to a study presented virtually at Kidney Week, the annual meeting of the American Society of Nephrology. Vlado Perkovic, MBBS, Ph.D., and colleagues assessed the effects of oral methylprednisolone versus placebo on major kidney outcomes and safety in IgAN. In a double-blind trial, patients with high-risk IgAN were randomly assigned to methylprednisolone or placebo. Following an excess of serious infections in the steroid arm, the methylprednisolone dose was reduced and Pneumocystis jirovecii prophylaxis was added. During an average follow-up of 4.2 years, methylprednisolone reduced the risk for the primary outcome (composite of 40% eGFR decline or kidney failure [dialysis, transplantation, or death due to kidney disease]; HR, 0.53) and end-stage kidney disease (HR, 0.59). “his risk reduction was observed across both dose protocols (HRs for full dose and reduced dose, 0.58 and 0.27, respectively),” Dr. Perkovic wrote.
Kidney Recovery From KRT Occurs in Only One-Quarter of Patients
Kidney recovery from kidney replacement therapy (KRT) occurred in only one-quarter of patients and was very unlikely after 3 months, according to a study published in the American Journal of Kidney Diseases. Jennifer A. Flemming, MD, and colleagues conducted a population-based, retrospective cohort study of adult patients identified as having cirrhosis at the time of hospital admission for acute kidney injury (AKI) requiring KRT. Kidney recovery was defined as the absence of KRT for at least 30 days. The cumulative incidences of kidney recovery, death, and liver transplantation were calculated at 1, 3, 6, and 12 months, and independent predictors of kidney recovery were evaluated using competing for risk regression models that generated sub-distribution HRs (sHR). Overall, 722 patients were included (median age, 61; MELD-Na score, 26; 52% with viral hepatitis, 25% non-alcoholic fatty liver disease, and 18% alcohol-associated liver disease). The cumulative incidences of kidney recovery at 1, 3, 6, and 12 months were 3%, 22%, 25%, and 26%, respectively. Higher MELD-Na score (sHR, 0.72 per 5 units; 95% CI, 0.65-0.80), acute-on-chronic liver failure (sHR, 0.61; 95% CI, 0.43-0.86), and sepsis (sHR, 0.57; 95% CI, 0.41-0.81) were associated with a lower hazard of kidney recovery, while those on a liver transplant waitlist (sHR, 3.10; 95% CI, 1.96-4.88) and who were admitted to a teaching hospital (sHR, 1.48; 95% CI, 1.05-2.08) were more likely to recover. “these findings provide information regarding prognosis that may guide decisions regarding KRT initiation and continuation,” Dr. Flemming wrote.
