The Humanistic Burden of Focal Segmental Glomerulosclerosis on Patients and Care‑Partners in the United States
Quality of Life Research – 2025
Cardiovascular, Kidney Failure, and All-Cause Mortality Events in Patients with FSGS in a US Real-World Database
Journal article
Published on May 15, 2024
Contributors:
Velez JCQ, Thakker KM, Bensink ME et al.
Velez JCQ, Thakker KM, Bensink ME et al.
DOI:
10.34067/KID.0000000000000469
10.34067/KID.0000000000000469
Summary
Real-world study examines associations between proteinuria, kidney failure (KF), cardiovascular events, and mortality rate for focal segmental glomerulosclerosis (FSGS)1
Background
Focal segmental glomerulosclerosis (FSGS) is a group of heterogeneous conditions marked by glomerular lesions and associated with proteinuria, declining kidney function, and increased cardiovascular risk.1-5
Despite the rarity of the condition, the FSGS disease burden is high, as it is the leading glomerular cause of kidney failure (KF) in the United States (US).1,6
The FSGS mortality rate remains poorly characterized, with few studies examining associations between elevated proteinuria, KF status, and cardiovascular disease (CVD) or all-cause mortality events in the US.1
Aim
This study assessed the impact of proteinuria on FSGS outcomes, including risk of KF, CVD events, and all-cause mortality.1 It also assessed whether progression to KF predicts higher risk of CVD or all-cause mortality in patients with FSGS.1
Approach
A retrospective observational cohort study was conducted using Optum Market Clarity data and FSGS diagnosis terms derived from natural language processing (NLP) data.1
Adults with ≥2 FSGS-related entries (ICD-10 or NLP terms) between 2007-2021 were included.1
Three subcohorts were analyzed to evaluate associations between1:
- Proteinuria and KF/all-cause mortality events
- KF status and CVD/all-cause mortality events
- Pre-KF proteinuria and CVD/all-cause mortality events
An exploratory subcohort was also analyzed to assess healthcare costs of FSGS.1
Findings
Elevated proteinuria was associated with worse outcomes1:
- Risk of KF/all-cause mortality was higher with baseline proteinuria:
- >1.5 g/g vs. ≤1.5 g/g: Adjusted hazard ratio (aHR): 2.34
- ≥3.5 g/g vs. <3.5 g/g: aHR: 2.44
- Risk of CVD/all-cause mortality was higher with baseline proteinuria:
- >1.5 g/g vs. ≤1.5 g/g: aHR: 2.11
- ≥3.5 g/g vs. <3.5 g/g: aHR: 2.27
Progression to KF was associated with a higher risk of CVD/all-cause mortality events (aHR: 3.04).1
Disease progression, nephrotic syndrome events, and CVD events were associated with significant incremental healthcare costs.1
Key takeaway
Elevated proteinuria and progression to KF were associated with a higher mortality rate for FSGS and increased cardiovascular risk in FSGS.1
Treatments that meaningfully reduce proteinuria and slow kidney function decline may help lower the risk of KF, CVD, and early mortality in patients with FSGS.1
Related Content
The Humanistic Burden of Focal Segmental Glomerulosclerosis on Patients and Care‑Partners in the United States
Quality of Life Research – 2025
Kidney Failure Attributed to Focal Segmental Glomerulosclerosis: A USRDS Retrospective Cohort Study of Epidemiology, Treatment Modalities, and Economic Burden
Kidney Medicine – 2023
Footnotes
aHR, adjusted hazard ratio; CVD, cardiovascular disease; FSGS, focal segmental glomerulosclerosis; ICD-10, International Classification of Diseases, 10th Revision; KF, kidney failure; NLP, natural language processing.
- Velez JCQ et al. Kidney360. 2024;5:1145-1153.
- Abbate M et al. J Am Soc Nephrol. 2006;17(11):2974–2984.
- De Vriese AS et al. J Am Soc Nephrol. 2018;29(3):759–774.
- Rosenberg AZ and Kopp JB. Clin J Am Soc Nephrol. 2017;12(3):502–517.
- Kidney Disease: Improving Global Outcomes KDIGO Glomerular Diseases Work Group. Kidney Int. 2021;100(4S):S1–S276.
- Shabaka A et al. Nephron. 2020;144(9):413–427.
MA-DS-25-0052 | June 2025