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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
  • Canney, Mark, University of British Columbia, Vancouver, British Columbia, Canada
  • Coppo, Rosanna, Fondazione Ricerca Molinette, Torino, Italy
  • Zhang, Hong, Peking University First Hospital, Beijing, China
  • Suzuki, Yusuke, Juntendo University School of Medicine, Tokyo, Japan
  • Induruwage, Dilshani, BC Provincial Renal Agency , Vancouver, British Columbia, Canada
  • Reich, Heather N., Toronto General Hospital, Toronto, Ontario, Canada
  • Cattran, Daniel C., Toronto General Hospital, Toronto, Ontario, Canada

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 (Pt) 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 ≥Pt). The net benefit and reduction in treatment were calculated for all Pt from 0 to 1.

Results

Using proteinuria ≧1g/day to make treatment decisions was net harmful to patients for Pt ≥0.18 (Fig A). Compared to using proteinuria, decisions using the Prediction Tool had a larger net benefit and net reduction in treatment for Pt ≥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.