Kidney Week

Abstract: PO1583

International IgA Nephropathy Network (IIgANN) Risk Prediction and Longitudinal Outcomes in the First South-Asian Prospective IgA Nephropathy Cohort (GRACE-IgANI)

Session Information

• Glomerular Diseases: Clinicopathological Features and Outcomes in IgAN, Lupus Nephritis, and Vasculitis
  November 04, 2021 | Location: On-Demand, Virtual Only
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

• Alexander, Suceena, Christian Medical College Vellore, Vellore, Tamil Nadu, India

Suceena Alexander, MD, MBBS, FASN

• Varughese, Santosh, Christian Medical College Vellore, Vellore, Tamil Nadu, India

Santosh Varughese,

• Thomas, Athul, Christian Medical College Vellore, Vellore, Tamil Nadu, India

Athul Thomas,

• Eapen, Jeethu Joseph, Christian Medical College Vellore, Vellore, Tamil Nadu, India

Jeethu Joseph Eapen,

• John, Elenjickal Elias, Christian Medical College Vellore, Vellore, Tamil Nadu, India

Elenjickal Elias John,

• Valson, Anna T., Christian Medical College Vellore, Vellore, Tamil Nadu, India

Anna T. Valson,

• David, Vinoi George, Christian Medical College Vellore, Vellore, Tamil Nadu, India

Vinoi George David,

• Daha, Mohamed R., Universitair Medisch Centrum Groningen, Groningen, Groningen, Netherlands

Mohamed R. Daha,

• John, George, Christian Medical College Vellore, Vellore, Tamil Nadu, India

George John,

• Feehally, John, University of Leicester, Leicester, Leicestershire, United Kingdom

John Feehally,

• Barratt, Jonathan, University of Leicester College of Life Sciences, Leicester, Leicester, United Kingdom

Jonathan Barratt,

Background

The Glomerular Research And Clinical Experiments- IgA Nephropathy in Indians is a prospective longitudinal cohort registered with WHO trial id: ISRCTN36834159. The performance of the IIgANN risk prediction score (Barbour et al.) has not been assessed in South Asian IgAN.

Methods

201 consenting adult IgAN patients were consecutively recruited post kidney biopsy. 195 patients (97%) completed 3 year longitudinal follow-up. Of these, 180 patients had complete Oxford MEST-C score at baseline. Composite outcome (CO) was defined as ≥50% fall in eGFR from baseline and/or eGFR <15ml/min/1.73m2 or RRT/death.

Results

The median predicted 3-year risk of a 50% decline in eGFR or ESKD using the IIGANN risk prediction tool was 18.1% (IQR 7.4–31.2) at baseline. The minimum score was 0.64% and the maximum was 53%. Short course IS was used in 146/201 (73%) of patients. 72 patients (36.9%) experienced CO over 3 years. The median risk in patients with favourable outcome was 13.15% (IQR 4.2–21.7) and in those with CO was 32.2% (IQR 19.6–41), P <0.0001 (Figure A). The area under the ROC curve for detecting CO was 0.81 (95% C.I. 0.74 to 0.88, P <0.0001) (Figure B). The specificity for predicting CO for percentage risk score >23 was 80% (95% C.I. 72 to 86), and >30 was 90% (95% C.I. 83 to 94).

Conclusion

IIgANN predicted 3-year risk score >23% has good specificity for predicting CO over 3 years. Overall the score seems to be underestimating the actual CO over 3 years in the GRACE-IgANI cohort. This requires further validation.

Barbour et al. 3 year prediction score and actual Composite Outcome over 3 years in GRACE-IgANI cohort.

Funding

• Government Support – Non-U.S.