MO312MAIN TRENDS AND OUTCOMES OF KIDNEY DISEASE IN GEORGIA: THE FIRST REVIEW OF KIDNEY BIOPSY DATABASE FROM 2011 TO 2020
Authors: Sarishvili Nora , Tchokhonelidze Irma , Tevdoradze Tamar , Kasradze Tamar , Ketevan Dalakishvili , Babutsidze Nona , Metskhvarishvili Gvantsa , Rusia Rusudan , Buadze Nino , Gazdeliani George , Bagashvili Tamar , Tataradze Avtandil , Beglarashvili Lela , Maglakelidze Nino , Pachulia Natia , Sutidze Merab 
Published: May 2021

Abstract

Background and Aims
Kidney biopsy registry has been established in Georgia in 2011 by Dialysis, Nephrology and Kidney Transplantation Union of Georgia (DNT Union) to address the natural history of kidney disease, describe the clinical features, improve disease understanding and tracking, healthcare planning, patient care and outcomes. This report is the first review of histological data over a period of 10 years (2011-2020) covering the entire population of 3.7 million inhabitants and demonstrates the current data on trends of kidney disease in Georgia.

Method
1267 ultrasound-guided kidney biopsies were performed during the 10 years. Data were extracted from the DNT Union kidney biopsy registry as of 1st of December 2020. Data on kidney function, urinalysis, treatment options and outcomes were also included in biopsy registry database. After exclusion of transplant and re-biopsies, kidney biopsies were analyzed for evaluation main trends in kidney biopsy rates and diagnosis of glomerular and non-glomerular diseases in two groups divided in 5-year time frames: the first group 2011-2015 and the second group 2016-2020. The overall treatment outcome was evaluated as complete remission (CR), partial remission (PR) and progression to ESRD.

Results
Final cohort consisted of 1089 patients. Mean age was 39 years [SD 13 years]. Fifty five percent of the cohort were male. The average annual biopsy incidence was 455 biopsies in the first group and 634 cases in the second group. The most common indication as clinical syndrome for performing the kidney biopsy was a decrease of glomerular filtration rate GFR (35%), followed by nephrotic syndrome (30%) and nephritic syndrome (21 %) and in lesser degree asymptomatic urinary abnormalities (14 %).
The frequency of kidney biopsies increased significantly over the years (Fig.1). The distribution of major histological groups of kidney disease in both groups is shown in the Table 1. As for comparison of the major trends among various histological patterns, there was 3,6 times more heredity kidney diseases diagnosed in the second group, followed by tubulointerstitial nephritis with 3.3 times increase, acute tubular necrosis 1.5 times increase and glomerulonephritis (primary and secondary) with 1.3 times increase. There was found statistically no changes in the incidence of vascular kidney disease between two groups (p=0.005).
Overall outcome demonstrates some changes during the time. PR was the most prevalent outcome in both time groups. However, proportion of PR cases increased (45%vs.64%) and proportion of CR (25% vs.17%) and ESRD (30% vs.18%) cases decreased. This change is statistically significant at p&lt;0.0001. There were no data obtained from 15% (173) of patients.
The distribution of overall outcome among patients with primary glomerulonephritis (PGN) repeated the same trend. Out of total PGN patients (481 cases) 61% showed PR, 24% reached CR and 15% progressed to ESRD. The proportion of patients with PR was higher (69%) among patients diagnosed with PGN in the second group compared with the first (48%). Proportion of patients, who developed ESRD, was lower in the second group (12% vs.19%).
( Fig. 2).

Conclusion
The present data are an important contribution to the epidemiology of kidney disease in Georgia. The incidence of glomerulonephritis generally increased between 2011 and 2020, that may be related to changes in kidney biopsy policy. Substantial decrease in numbers of kidney biopsies were registered in 2020 due to pandemic issues. Membranous nephropathy was the most common primary glomerular disease according to the registry database. The prognosis regarding progression to ESRD has improved.