The long-term survival outcome in older patients with different pathological types of chronic kidney disease

Introduction: Chronic kidney diseases (CKD) are prevalent in older people and renal pathological manifestations are important for diagnosis, treatment and prognosis. However, the long-term survival outcome and risk factors for older CKD patients with different pathological types are not fully understood and need to be further investigated.Methods: Medical data were recorded and all-cause mortality were followed up in patients underwent renal biopsy diagnosed in Guangdong Provincial people hospital from 2005 to 2015. Kaplan-Meier analysis were used to identify the incidence of survival outcomes. Multivariate Cox regression models and Nomogram were applied to analyze pathological types and other factors for overall-survival outcomes.Results: 368 cases were included and the median of follow-up was 85 (46.5, 111) months. Overall mortality was 35.6%. The highest mortality was mesangioproliferative glomerulonephritis (MPGN) group (88.9%), followed by amyloidosis (AMY) group (84.6%), and the lowest mortality was minimal change disease (MCD) group (21.9%). Moreover, multivariate Cox regression model showed that survival times of MPGN (HR =8.215 [CI 95% 2.735, 24.674], p < 0.001) and AMY (HR =6.130 [CI 95% 2.219, 16.94], p < 0.001) were significantly shorter than MCD. In addition, age, lower baseline eGFR, history of chronic obstructive pulmonary disease (COPD) and cerebrovascular accidents (CVA)/transient ischemic attack (TIA), MPGN and AMY were independent risk factors for the mortality of older patients with CKD.Conclusion: The long-term survival outcome of older CKD patients showed differences among different pathological types, and MPGN, AMY, age, baseline eGFR, CVA/TIA and COPD were independent predictors for mortality.