A Systematic Literature Review of the Epidemiology, Health-Related Quality of Life Impact, and Economic Burden of Immunoglobulin A Nephropathy

Abstract

Introduction: This systematic literature review analyzed published evidence on IgA nephropathy (IgAN), focusing on US epidemiology, health-related quality of life (HRQoL), and economic burden of illness.Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Embase®, MEDLINE®, Cochrane, and Econlit (January 2010 to June 2020) were searched, along with relevant congresses (2017)(2018)(2019)(2020).Results: Of 123 epidemiologic studies selected for data extraction, 24 reported IgAN diagnosis rates ranging from 6.3% to 29.7% among adult and pediatric patients undergoing renal biopsy, with all reported US rates <15%. No US studies reported IgAN prevalence. A meta-analysis of US studies calculated an annual incidence of 1.29/100 000 people, translating to an annual US incidence of 4236 adults and children. Relative to Europe, the United States had more patients diagnosed with IgAN in later chronic kidney disease stages. US rates of transition to end-stage renal disease (ESRD) ranged from 12.5% to 23% during 3-3.9 years of observation, rising to 53% during 19 years of observation. Across 8 studies reporting HRQoL, pain and fatigue were the most reported symptoms, and patients consistently ranked kidney function and mortality as the most important treatment outcomes. Patients with glomerulopathy reported worse mental health than healthy controls or hemodialysis patients; proteinuria was significantly associated with poorer HRQoL and depression. Conclusion:While economic evidence in IgAN remains sparse, management of ESRD is a major cost driver. IgAN is a rare disease where disease progression causes increasing patient burden, underscoring the need for therapies that prevent kidney function decline and HRQoL deterioration while reducing mortality. 37Kwon CS, et al. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCHthe potential for underdiagnosis or diagnostic delay in regions with limited screening, particularly for patients without severe symptoms. 2,3 It has been reported that up to 50% of patients with IgAN progress to ESRD within 20 years of clinical presentation. 4,[10][11][12] Risk factors for progression to ESRD include persistent proteinuria, hypertension, and reduced glomerular filtration rate. 6,9 Consequences of advanced CKD and kidney failure in IgAN include requirement for dialysis or transplantation, poor health-related quality of life (HRQoL), and increased mortality. 3,4,[13][14][15] Symptoms of CKD and adverse events due to dialysis have a substantial impact on HRQoL, daily living, and ability to work. 13,14 Moreover, patients who undergo transplantation remain at risk of IgAN recurrence due to the underlying pathophysiology. 16 All GN subtypes have the potential to recur post-transplantation, with the prevalence of GN recurrence between 3% and 15%. 17 In addition, kidney transplant patients must deal with the associated life-long regimen of medications to reduce the risk of graft rejection, lifestyle changes, self-care, and medical appointments required to maintain t...

LC-MS/MS based metabolomics and proteomics reveal candidate biomarkers and molecular mechanism of early IgA nephropathy

“…Several studies suggested that PRKAR2A was associated with inflammatory pain and that antagonizing PRKAR2A offered a practical solution to controlling inflammatory pain [ 38 , 39 ]. A systematic literature review of IgAN has described that across 8 studies reporting health-related quality of life, pain and fatigue were the most reported symptoms [ 40 ]. In this study, decreased abundance of plasma PRKAR2 was observed among IgAN patients.…”

COVID-19 and Glomerular Diseases

“…IgAN is the most common GN globally, and is more common in the East and Pacific Asian countries. 48 Patients typically present with microscopic or gross hematuria. Proteinuria is common, and is associated with progression of kidney disease.…”

“…Light microscopy shows moderate to diffuse cellular to fibrocellular crescents associated with ruptured Bowman’s capsule. 48 , 49 , 50 , 51 , 52 , 53 , 54 The degrees of glomerulosclerosis ranges from mild to severe. 72 ATI is common with inflammatory infiltrates in some cases, and tubulitis may be observed.…”

Cost-Effectiveness Analysis of Nefecon versus Best Supportive Care for People with Immunoglobulin A Nephropathy (IgAN) in the United States

“… 3 A meta-analysis based on published United States (US) studies estimated an annual incidence of 1.29 per 100,000 people. 4 It occurs with the highest frequency in East Asians and Caucasians and is relatively rare in individuals of African ancestry. 5 IgAN is characterized by the formation and amplification of pathogenic immunoglobulin A (IgA) immune complexes that deposit within the glomeruli of the kidney, 2 , 6 , 7 and results in signs and symptoms including proteinuria (protein excreted in the urine), hematuria (blood in the urine), and hypertension.…”