ESKD from primary glomerulonephritis: Incidence and post KRT survival: A national cohort study in the UK

Abstract

Background Primary glomerulonephritis (pGN) is a significant contributor to end-stage kidney disease (ESKD) and presents a significant healthcare burden. However, the epidemiology of ESKD-pGN in the UK remains poorly characterised. Methods We analysed UK Renal Registry data for adults initiating kidney replacement therapy (KRT) between 1999 and 2019, with follow-up to December 2021. The incident cohort included patients starting KRT from 2008 onwards, when national population coverage was achieved, reflecting incidence of KRT initiation due to primary glomerulonephritis rather than overall disease incidence. Incidence rates were normalised to population and analysed using multivariable Poisson regression. Overall patient and graft survival were assessed using Cox regression models with time-dependent covariates, adjusted for demographic variables. Patients managed conservatively were not captured, limiting conclusions to advanced disease requiring KRT. Adult polycystic kidney disease (ADPKD) served as a reference disease. Results The cohort included 10,308 pGN and 8,302 ADPKD patients. Median age at KRT start in pGN was 54 years, with 71.6% male. Overall incidence of KRT from pGN was 11.8 pmp, with rates of 17.4 pmp for males and 6.6 pmp for females, mainly driven by IgAN, rising until 2015 then declining. ADPKD incidence was 9.8 (males) and 8.2 (females) pmp. Incidence varied by age, sex, and deprivation, with higher rates in older adults with MN (IRR 1.75, 95% CI 1.45–2.11) and MPGN (IRR 1.70, 95% CI 1.22–2.38) compared with ADPKD. Pre-emptive transplantation was less common in pGN (13.5%) than ADPKD (22.8%). Overall survival was similar, but outcomes differed by modality: in pGN, 10-year survival was 81.8% after transplantation, 55.5% on PD, and 37.9% on haemodialysis. Among pGN subtypes, IgAN had favourable graft survival and comparable 5-year survival on PD and transplantation (92.1% vs 92.6%). Graft survival was highest in ADPKD. Conclusions This national study reveals evolving epidemiology from ESKD-pGN in the UK. These findings may inform resource allocation, and targeted interventions to enhance care and outcomes in pGN.