Table 1 showed that patients from Guangxi exhibited advanced age, a higher proportion of male individuals, elevated systolic and diastolic blood pressure levels, increased serum PLA2R antibody concentration, uric acid, total cholesterol, and urine protein levels, as well as decreased hemoglobin, serum albumin, and baseline eGFR compared to patients from other regions. The thickness of basement membrane, the proportion of spherical sclerosis, the proportion of focal segmental sclerosis, the proportion of renal arteriole wall thickening, the proportion of tubular atrophy, the proportion of interstitial inflammatory cell infiltration, and the proportion of renal PLA2R deposition 2+~3+ were higher in Guangxi area.
Table 1 Baseline data for PMN patients in different regions
Variable
|
Guangdong region group(n=300)
|
Guangxi region group(n=362)
|
P-value
|
Gender (male%)
|
183 (61.0)
|
226 (62.4)
|
0.706
|
Ages
|
46.0 ± 14.5
|
50.4 ± 13.4
|
<0.001
|
Systolic pressure,mmhg
|
130.4 ± 22.8
|
143.4 ± 23.9
|
<0.001
|
Diastolic pressure,mmhg
|
85.2 ± 17.4
|
87.3 ± 13.6
|
<0.001
|
Serum PLA2R,ng/ml
|
122.7 ± 285.1
|
157.1 ± 268.5
|
0.006
|
Hemoglobin,g/L
|
132.3 ± 19.7
|
126.8 ± 21.2
|
<0.001
|
Albumin,g/L
|
26.9 ± 7.3
|
24.7 ± 5.4
|
<0.001
|
Total cholesterol,mmol/L
|
7.1 ± 2.3
|
8.3 ± 2.5
|
<0.001
|
24-hour urine protein quantification,g
|
5034.7 ± 4505.5
|
5.5 ± 3.5
|
<0.001
|
Uric acid,umol/l
|
388.4 ± 95.8
|
416.4 ± 126.5
|
0.010
|
eGFR[ml·min-1·(1.73 m2)-1]
|
110.6 ± 35.7
|
98.7 ± 43.6
|
<0.001
|
Thickness of basement membrane,nm
|
1192.0 ± 456.4
|
1301.6 ± 447.9
|
0.066
|
Proportion of spherical sclerosis,%
|
6.8 ± 11.8
|
7.6 ± 11.4
|
<0.001
|
Proportion of focal segmental sclerosis,%
|
0.9 ± 3.7
|
2.9 ± 6.7
|
<0.001
|
Renal arteriole wall thickening ,n(%)
|
165 (55.0%)
|
271 (74.9%)
|
0.012
|
Tubular atrophy,n(%)
|
153 (51.0%)
|
220 (60.8%)
|
<0.001
|
Interstitial inflammatory cell infiltrate ,n(%)
|
219 (73.0%)
|
307 (84.8%)
|
0.009
|
Renal PLA2R deposition
|
|
|
<0.001
|
Negative,n(%)
|
14 (7.6%)
|
12 (6.1%)
|
|
Weak positive,n(%)
|
15 (8.2%)
|
4 (2.0%)
|
|
1+,n(%)
|
112 (60.9%)
|
73 (37.1%)
|
|
2+,n(%)
|
26 (14.1%)
|
87 (44.2%)
|
|
3+,n(%)
|
17 (9.2%)
|
21 (10.7%)
|
|
Note: P<0.05 was statistically significant.
Table 2 showed that region, age, systolic blood pressure, diastolic blood pressure, serum PLA2R tibody, albumin, total cholesterol, 24-hour urine protein quantification, uric acid, eGFR, spherical sclerosis ratio, focal segmental sclerosis ratio, renal arteriolar wall thickening, renal tubular atrophy, and interstitial inflammatory cell infiltration were the relevant influencing factors for the 30% decrease in eGFR in PMN patients.
Table 2 Univariate COX analysis of renal endpoints
|
Statistics
|
decreased by 30%
|
P-value
|
Patients in Guangxi ,n(%)
|
362 (54.68%)
|
14.78 (9.62, 22.72)
|
<0.0001
|
Gender (male%)
|
409 (61.78%)
|
1.16 (0.84, 1.60)
|
0.3821
|
Ages
|
48.37 ± 14.06
|
1.03 (1.02, 1.04)
|
<0.0001
|
Systolic pressure,mmhg
|
137.51 ± 24.28
|
1.02 (1.01, 1.02)
|
<0.0001
|
Diastolic pressure,mmhg
|
86.37 ± 15.46
|
1.02 (1.01, 1.03)
|
0.0036
|
Serum PLA2R antibody ,ng/ml
|
144.73 ± 274.38
|
1.00 (1.00, 1.00)
|
0.0108
|
Hemoglobin,g/L
|
129.27 ± 20.71
|
0.99 (0.99, 1.00)
|
0.0609
|
Albumin,g/L
|
25.68 ± 6.42
|
0.94 (0.92, 0.97)
|
<0.0001
|
Total cholesterol,mmol/L
|
7.77 ± 2.49
|
1.11 (1.04, 1.18)
|
0.0015
|
24-hour urine protein quantification,g
|
2284.63 ± 3931.86
|
1.00 (1.00, 1.00)
|
<0.0001
|
Uric acid,umol/l
|
403.73 ± 114.37
|
1.00 (1.00, 1.00)
|
0.0325
|
eGFR[ml·min-1·(1.73 m2)-1]
|
103.96 ± 40.75
|
0.99 (0.99, 1.00)
|
0.0067
|
D-dimer
|
1.97 ± 4.74
|
1.03 (0.98, 1.07)
|
0.2187
|
Proportion of spherical sclerosis,%
|
7.23 ± 11.56
|
1.02 (1.01, 1.04)
|
0.0018
|
Proportion of focal segmental sclerosis,%
|
2.01 ± 5.66
|
1.04 (1.01, 1.08)
|
0.0036
|
Renal arteriolar wall thickening .n(%)
|
436 (65.86%)
|
2.08 (1.47, 2.94)
|
<0.0001
|
Tubular atrophy,n(%)
|
373 (56.34%)
|
1.79 (1.30, 2.47)
|
0.0004
|
Interstitial inflammatory cell infiltration,n(%)
|
526 (79.46%)
|
2.35 (1.53, 3.59)
|
<0.0001
|
Note: P<0.05 was statistically significant.
Table 3 showed that following adjustment for potential confounding variables including gender, age, ethnicity, history of hypertension, history of diabetes, body mass index, hemoglobin, serum albumin, total cholesterol, eGFRMDRD, proportion of globular sclerosis, and proportion of focal segmental sclerosis, distinct geographical regions emerged as significant independent risk factors for a 30% reduction in eGFR among PMN patients. Specifically, the risk of reaching the renal endpoint in the Guangxi region was 7.84 times greater compared to the Guangdong region (OR=7.84, 95% CI 4.94-12.44, P<0.001).
Table 3 Multivariate COX analysis of renal endpoints
Variables
|
Model I(HR ,95%CI,P)
|
Model II(HR ,95%CI,P)
|
Geographical grouping
|
|
|
Guangdong Group
|
1.0
|
1.0
|
Guangxi Group
|
14.78(9.62, 22.72)<0.001
|
7.84 (4.94, 12.44) <0.001
|
Systolic pressure
|
1.01 (1.00, 1.01) 0.0275
|
1.00 (1.00, 1.01) 0.5669
|
Total cholesterol
|
1.07 (1.02, 1.12) 0.0070
|
1.01 (0.95, 1.07) 0.7940
|
D-dimer
|
1.02 (1.00, 1.04) 0.0553
|
1.01 (0.98, 1.04) 0.4445
|
Note 1: Model I: No adjustment for confounding factors, Model II: Adjusted for confounding factors: gender, age, ethnicity, history of hypertension, history of diabetes, body mass index, hemoglobin, serum albumin, total cholesterol, eGFRMDRD, proportion of globular sclerosis, proportion of focal segmental sclerosis
Note 2: P<0.05 was statistically significant.
Figure 2 showed that the proportion of kidney endpoints reached was lower in the Guangdong group than in the Guangxi group, and the 1st, 3th, and 5th year renal survival rates were 90.8%, 85.6%, and 82.5%, and the 1st, 3th, and 5th year renal survival rates in the Guangxi group were 52.2%, 42.8%, and 27.3%. The difference was statistically significant (P<0.0001).
Interaction test analysis
Table 4 showed that there are significant differences in the effects of different regions on the incidence of renal endpoints in different eGFR classifications, and there are certain interactions.
Table 4 Analysis of the interaction test
|
eGFR ertile
(mL/min/1.73 m²)
|
Model I
|
Model II
|
Guangdong group
|
Low(<30)
|
Ref.
|
Ref.
|
Guangxi group
|
Low(<30)
|
2.89 (1.67, 4.98) 0.0001
|
3.86 (2.02, 7.37) <0.0001
|
Guangdong group
|
Middle(≥30,<90)
|
0.41 (0.18, 0.94) 0.0359
|
0.48 (0.19, 1.21) 0.1190
|
Guangxi group
|
Middle(≥30,<90)
|
3.18 (1.83, 5.53) <0.0001
|
4.71 (2.33, 9.54) <0.0001
|
Guangdong group
|
High(≥90)
|
0.24 (0.10, 0.58) 0.0016
|
0.30 (0.09, 0.96) 0.0425
|
Guangxi group
|
High(≥90)
|
2.97 (1.68, 5.23) 0.0002
|
4.51 (1.85, 11.00) 0.0009
|
P interaction
|
|
0.0053 (0.0014 #)
|
0.0258 (0.0082 #)
|
Model I: No adjustment for confounders; Model II: Adjusted for confounders: gender, age, ethnicity, history of hypertension, history of diabetes, body mass index, hemoglobin, serum albumin, total cholesterol, eGFRMDRD, proportion of globular sclerosis, proportion of focal segmental sclerosis.