FSGS - How it affects Kidney Failure and Cardiovascular Disease

Key Points 

• In patients with FSGS, elevated proteinuria and progression to kidney failure (KF) were associated with a higher risk of cardiovascular disease in relation to all-cause mortality events.

• In addition, elevated pre-KF proteinuria was associated with KF in relation to all-cause mortality events.

  
  

Background 

Many diseases and conditions can affect your kidney function by attacking and damaging the glomeruli. Glomeruli are tiny filtering units inside your kidney where blood is cleansed. Focal segmental glomerulosclerosis (FSGS) is a condition where the glomeruli are scarred, or sclerosed, in segments of your kidneys leading to proteinuria (protein in the urine) and progressive decline in glomerular filtration rate (GFR) (the rate at which your glomeruli can filter your blood). These conditions correlate with kidney failure (KF) and increased cardiovascular risk. A recent study was conducted to estimate the effects of proteinuria on kidney failure (KF) status in relation to all causes of death and cardiovascular disease (CVD) events in relation to all causes of death. Additionally it was tested to see if there wasa relationship between progression to KF and occurrence of CVD in relation to mortality events among adult patients (18 years or older) with FSGS.

Methods 

This study was an observational, retrospective cohort study utilizing Optum deidentified Market Clarity Data and proprietary Natural Language Processing data. That is a fancy way of saying the the study looked at previous studies to determine the results of this study. The period studied was from January 1, 2007, through March 31, 2021, with patients in the overall cohort being identified from July 1, 2007, through March 31, 2021.

Results 

Elevated proteinuria >1.5 and ≥3.5 g/g increased the risk of KF in relation t

o all-cause mortality (2) and CVD in relation to all-cause mortality (3). Progression to KF was also associated with a higher risk of CVD in relation to all-cause mortality. (4)

Conclusions 

A significant proportion of patients with FSGS experience KF and CVD events. Elevated proteinuria and progression to KF were associated with a higher risk of CVD in relation to all-cause mortality events, and elevated pre-KF proteinuria was associated with progression to KF in relation to all-cause mortality events. Treatments that meaningfully reduce proteinuria and slow the decline in GFR have the potential to reduce the risk of CVD, KF, and early mortality in patients with FSGS.

1. Velez, Juan Carlos Q.1,2; Thakker, Kamlesh M.3; Bensink, Mark E.4; Lerma, Edgar V.5; Lieblich, Richard6; Bunke, C. Martin7; Gong, Wu4; Wang, Kaijun4; Rava, Andrew R.8; Amari, Diana T.8; Oliveri, David8; Murphy, Michael V.8; Cork, David M.W.9. Cardiovascular, Kidney Failure, and All-Cause Mortality Events in Patients with FSGS in a US Real-World Database. Kidney360 5(8):p 1145-1153, August 2024. | DOI: 10.34067/KID.0000000000000469

2. Adjusted hazard ratio [HR] [95% confidence interval (CI)], 2.34 [1.99 to 2.74] and 2.44 [2.09 to 2.84], respectively

3. Adjusted HR [95% CI], 2.11 [1.38 to 3.22] and 2.27 [1.44 to 3.58], respectively

4. Adjusted HR [95% CI], 3.04 [2.66 to 3.48]