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Abstract: PO1640

Long-Term Follow-Up Study of Immunosuppressive Therapy in IgAN Patients with CKD Stage 3 and 4

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Author

  • Ni, Yuehui, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
Background

The benefits of immunosuppressive therapy in patients with IgAN remain controversial, especially for those with more severe renal pathology and reduced renal function.

Methods

A total of 496 primary IgAN patients were screened between 2012 to 2014. Patients were divided to 4 groups according to CKD stage and the treatment. The primary endpoints were doubling of creatinine,progression to ESRD or death. The secondary endpoint was decrease in eGFR. Subgroup analysisof CKD3 immunosuppressive treatment group was conducted to explore the factors affecting the prognosis after treatment.

Results

164 patients were enrolled and mean follow-up time was 5.5 years.There were 126 patients in CKD3 stage and 38 patients in CKD4 stage.Immunosuppressive therapy significantly improved prognosis in patients with CKD stage3 (HR 0.435[95%CI 0.200-0.944];p=0.035), but no difference for CKD stage4(p=0.364).Subgroup analysis showed baseline eGFR(OR 0.909[95%CI 0.834-0.991];p=0.031), serum IgG level(OR 0.809 [95%CI 0.658-0.995];p=0.045) were associated with primary outcome and loop necrosis(OR 0.189[95% CI 0.050-0.709],p=0.014), proportion of crescents(OR 0.200[95% CI 0.100-0.521],p=0.003), interstitial fibrosis>50%(OR 5.490[95%CI 1.323-22.727]) were associated with secondary outcome.Remission within 1 year could be an indicator of good long-term prognosis (HR 0.555[95%CI 0.296-0.759; p=0.035]).

Conclusion

For IgAN patients with CKD stage3, immunosuppressive therapy should be actively applied under the general treatment, but for patients with CKD stage4, it should be carefully.Patients with good renal function, more acute lesions of renal pathology would have a better prognosis after immunosuppressive therapy. Patients who achieved remission within 1 year would have better long-term prognosis.