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Fabry disease (FD) is a disorder resulting from the GLA gene mutations and α-galactosidase-A enzyme deficiency, often causing progressive renal impairment and end-stage kidney disease. This study aimed to assess epidemiology in a large FD patient cohort managed in a single centre, with a specific focus on identifying factors associated with renal disease progression. Data were retrospectively collected from electronic patient records. The analysis included patients with at least three eGFR values over one year, categorized as ‘slow progressors’(eGFR slope≤− 1 ml/min/year),‘intermediate progressors’(− 1 to− 3 ml/min/year), and ‘fast progressors’(>− 3 ml/min/year) to account for anticipated age-related eGFR decline. Univariate and multivariate logistic regression identified factors associated with accelerated eGFR decline and mortality (p< 0.05). In 395 FD participants followed for a median of 6.36 years (IQR …