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Abstract: TH-PO812

Plasma Galactose-Deficient IgA1/C3 Ratio Is Strongly Associated with Disease Progression in IgA Nephropathy

Session Information

Category: Glomerular Diseases

  • 1202 Glomerular Diseases: Immunology and Inflammation

Authors

  • Chen, Pei, Peking University First Hospital, Beijing, China
  • Yu, Gui-zhen, Peking University First Hospital, Beijing, China
  • Zhang, Xue, Peking University First Hospital, Beijing, China
  • Shi, Sufang, Peking University First Hospital, Beijing, China
  • Lv, Jicheng, Peking University First Hospital, Beijing, China
  • Zhang, Hong, Peking University First Hospital, Beijing, China
Background

Galactose-deficient IgA1 (Gd-IgA1) and C3 mesangial codeposition is a hallmark of IgA nephropathy (IgAN). In this large cohort study, we aim to evaluate Gd-IgA1/C3 ratio in the progression of IgAN.

Methods

In this study, we included 1157 IgAN patients with a median follow-up period of 42 months. Plasma Gd-IgA1 was measured at the time of diagnosis using a lectin-based ELISA. The composite kidney failure event was defined by 50% decline in eGFR or ESRD and renal survival was modeled using the Cox proportional hazards method and restricted cubic splines.

Results

Although high plasma Gd-IgA1 levels were associated with the risk of kidney progression events, the association was not in a linear relationship. While the correlation between plasma Gd-IgA1/C3 ratio and risk of kidney failure was a linear relationship. After adjusted for traditional risk factors, higher levels of Gd-IgA1/C3 ratio was independently associated with a greater risk of deterioration in renal function with a HR of 2.15 (95% CI=1.21–3.81, P=0.008) per ln(Gd-IgA1/C3). In reference to the first quartile, the risk of kidney progression event increased such that the HR for the second quartile was 1.84 (95% CI=1.05–3.24, P=0.034), 1.79 (95% CI=1.02–3.12, P=0.041) for the third, and 2.08 (95% CI=1.22–3.54, P=0.007) for the fourth quartile of the Gd-IgA1/C3 ratio.

Conclusion

Plasma Gd-IgA1/C3 ratio was an independent risk factor for kidney progression events.

Cox regression model associations of baseline plasma Gd-IgA1/C3 levels with incidence of composite end point.
 HR (95% CI) and P value
 UnadjustedModel 1Model 2Model 3
Per ln(Gd-IgA1/C3)3.00 (1.73-5.21)3.02 (1.74-5.24)2.68(1.59-4.53)2.15(1.21-3.81)
P value8.9×10-58.1×10-52.2×10-40.008
Gd-IgA1/C3 quartiles    
1ReferenceReferenceReferenceReference
21.68(0.99-2.85)1.61(0.94-2.76)1.63(0.95-2.80)1.84 (1.05-3.24)
P value0.0550.0820.0760.034
31.97(1.17-3.31)1.90(1.13-3.22)2.10(1.24-3.55)1.79 (1.02-3.12)
P value0.0100.0160.0060.041
42.49(1.51-4.12)2.47(1.49-4.07)2.29(1.39-3.80)2.08 (1.22-3.54)
P value3.5×10-44.3×10-40.0010.007

Model 1 was adjusted for sex and age. Model 2 was adjusted for covariates in model 1 plus eGFR, proteinuria, and mean arterial blood pressure. Model 3 was adjusted for covariates in model 2 plus Oxford MESTC scores and steroids or other immunosuppressive agents .