Kidney Week

Abstract: TH-OR110

The Clinical Utility of Immunosuppression Treatment Decisions Based on Personalized Risk Assessment from the International IgA Nephropathy Prediction Tool

Session Information

• Mostly IgA Nephropathy
  November 07, 2019 | Location: Ballroom C, Walter E. Washington Convention Center
  Abstract Time: 04:54 PM - 05:06 PM

Category: Glomerular Diseases

• 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

• Barbour, Sean, University of British Columbia, Vancouver, British Columbia, Canada

Sean Barbour, MD



Dr. Barbour completed his internal medicine and nephrology training at the University of British Columbia in 2010. He subsequently did a two-year glomerulonephritis fellowship and Master of Science in clinical epidemiology at the University of Toronto. He is an Associate Professor with the UBC Division of Nephrology, with a clinical and research focus on glomerular diseases. He is the Medical Lead of the BC Provincial Renal Agency BC Glomerulonephritis Network and Registry, and Chair of the BC Glomerulonephritis Network Steering Committee. Through these positions, he is responsible for health policy and health services related to glomerular diseases in BC. Dr. Barbour’s research focus is on clinical trials, health outcomes and health services delivery in glomerulonephritis, and using prediction modeling techniques to improve risk stratification in glomerular diseases. He holds multiple peer-reviewed grants, including from the Michael Smith Foundation for Health Research, the Kidney Foundation of Canada, and the Canadian Institutes of Health Research.

• Canney, Mark, University of British Columbia, Vancouver, British Columbia, Canada

Mark Canney,

• Coppo, Rosanna, Fondazione Ricerca Molinette, Torino, Italy

Rosanna Coppo,

• Zhang, Hong, Peking University First Hospital, Beijing, China

Hong Zhang,

• Suzuki, Yusuke, Juntendo University School of Medicine, Tokyo, Japan

Yusuke Suzuki,

• Induruwage, Dilshani, BC Provincial Renal Agency , Vancouver, British Columbia, Canada

Dilshani Induruwage,

• Reich, Heather N., Toronto General Hospital, Toronto, Ontario, Canada

Heather N. Reich,

• Cattran, Daniel C., Toronto General Hospital, Toronto, Ontario, Canada

Daniel C. Cattran,

Group or Team Name

• International IgA Nephropathy Network

Background

The KDIGO guidelines recommend risk-stratifying patients with IgA nephropathy (IgAN) based on proteinuria ≧1g/day to guide immunosuppression treatment decisions. Because this approach does not accurately discriminate the risk of disease progression, we evaluated whether treatment decisions could be improved by using individual risk assessment from the International IgAN Prediction Tool, which estimates the 5-year risk of a 50% decline in eGFR or ESRD.

Methods

We used a net benefit and net reduction in treatment analysis, which for any given threshold probability of disease progression (P_t) balances correct decisions to give or withhold immunosuppression accounting for the relative harm to patients from incorrect decisions. In a multi-ethnic cohort of 3299 adults with biopsy-proven IgAN (median follow-up 5.1 years), decision rules for immunosuppression treatment were created based on proteinuria ≧1g/day or based on the Prediction Tool (predicted risk ≥P_t). The net benefit and reduction in treatment were calculated for all P_t from 0 to 1.

Results

Using proteinuria ≧1g/day to make treatment decisions was net harmful to patients for P_t ≥0.18 (Fig A). Compared to using proteinuria, decisions using the Prediction Tool had a larger net benefit and net reduction in treatment for P_t ≥0.09 and ≧0.08 (Fig B, C, D), and more accurately allocated or withheld immunosuppression in up to 23.4% and 35.1% more patients respectively.

Conclusion

These results demonstrate the benefit to patients from a precision-medicine approach to immunosuppression treatment using individual risk of disease progression from the International IgAN Prediction Tool instead of a single generic categorization of proteinuria.

Funding

• Government Support - Non-U.S.