Years of life lost and long-term outcomes due to glomerular disease in a Southeast Asian Cohort

Abstract

Death and end-stage kidney disease (ESKD) are major outcomes of glomerular disease. (GD) The years of potential life lost (YLL) may provide additional insight into the disease burden beyond death rates. There is limited data on premature mortality in GD. In this retrospective observational cohort study, we evaluated the mortality, ESKD rates, and YLL in Thais with biopsy-proven GD. The mortality and combined outcome rates were determined by log-rank test and ESKD by using a competing risk model. YLL and premature life lost before age 60 were calculated for different GD based on the life expectancy of the Thai population. Patients with GD (n = 949) were followed for 5237 patient years. The death rate and ESKD rates (95%CI) were 4.2 (3.7-4.9) and 3.3 (2.9-3.9) per 100 patient-years, respectively. Paraprotein-related kidney disease had the highest death rate, and diabetic nephropathy had the highest ESKD rate. Despite not having the highest death rate, lupus nephritis (LN) had the highest YLL (41% of all GD) and premature loss of life before age 60. In conclusion, YLL provided a different disease burden assessment compared to mortality rates and identified LN as the major cause of premature death due to GD in a Southeast Asian cohort.

Figure 1

Study flow.

Figure 2

The cumulative incidence of outcomes for different GD (n = 949). (a) Death. (b) End-stage kidney disease (ESKD). (c) Combined events (death or ESKD).

Figure 3

Years of life lost (YLL) by GD types (including diabetes). (a) All patients: Median YLL. Open circle denotes median with ends representing 25 and 75 percentile. (b) All patients: Proportion of total YLL. (c) Premature death before age 60: Median YLL60. Open circle denotes median with ends representing 25 and 75 percentile. (d) Premature death before age 60: Proportion of total YLL60.