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IgA nephropathy is the most common primary glomerular disease and an important cause of uremia in China.The treatment of IgAN nephropathy is divided into two main categories: symptomatic supportive therapy; and the use of glucocorticoids in combination with or without other immunosuppressive agents to treat active, inflammatory lesions. Due to conflicting results from existing evidence-based medical evidence, the timing and effectiveness of IgAN immunosuppressive drugs remains controversial.
A chronic kidney disease-specific database was constructed using the medical big data of the PLA General Hospital, which included IgAN patients in our hospital from 2015-2018, and collected variables including demographics, physical examination, diagnosis, major auxiliary tests, medication, endpoint events, and other characteristic variables. The information of patients' readmission and outpatient visits after discharge was used as follow-up information to form a real-world cohort.
A total of 1170 effective cases of IgA nephropathy were included in the study, including 487 cases in the glucocorticoid treatment group and 683 cases in the supportive treatment group. From baseline characteristics, the glucocorticoid-treated group had younger age, poorer renal function, lower serum albumin level, and higher neutrophil/lymphocyte ratio (NLR), and 81.1% of patients had a 24-hour urinary protein content of ＞ 1g (P<0.05). After treatment, the level of proteinuria decreased in both groups, and the decrease was greater in glucocorticoid treatment group (P<0.05). Although the baseline eGFR level was lower in the glucocorticoid-treated group, renal function improved and eGFR increased after treatment, with no significant difference in eGFR between the two groups at the last follow-up (P=0.5019). Although the 24-hour urinary protein quantity was higher in the glucocorticoid-treated group at baseline, there was no statistically significant difference in the complete remission rate of proteinuria between the two groups after treatment (P=0.9416). The partial remission rate of proteinuria was higher in glucocorticoid treatment group (P<0.05). After multifactor adjustment, young patients with low serum albumin, high baseline NLR and albuminuria, and low eGFR were more likely to choose glucocorticoid therapy (P<0.05).
The glucocorticoid treatment decision model of IgA nephropathy was established by using real world big data, which provides a convenient tool for clinical treatment decision of IgA nephropathy.