ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-PO657

Prevalence of Optimal Conservative Therapy Implementation Among CureGN Participants With IgA Nephropathy

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Rajasekaran, Arun, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
  • Larkina, Maria, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Julian, Bruce A., The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
  • Mariani, Laura H., University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Rizk, Dana, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
Background

Immunoglobulin A nephropathy [IgAN] is the most common primary glomerulonephritis in many countries; 20-40% of patients progress to kidney failure by 20 yr after diagnosis. Optimized supportive care is pivotal in addressing modifiable risk factors for progression, including hypertension and proteinuria. Through the Cure Glomerulopathy [CureGN] study, we sought to ascertain prevalence of optimal BP and proteinuria control, and maximal renin angiotensin aldosterone system inhibitor [RAASi] use among IgAN adults at enrollment and longitudinally.

Methods

CureGN, an observational longitudinal study, enrolled 458 adults ≥ 18 yr with primary IgAN within 5 yr of initial diagnostic kidney biopsy. BP was measured annually and urine protein-to-creatinine ratio [UPCR] values were obtained within 60 d of study visit. RAASi prescription patterns and dosing were ascertained at enrollment and longitudinally. Enrollment visits were classified as incident [< 6 mo of biopsy] or prevalent [≥ 6 mo post biopsy]. Goals for BP and proteinuria control were the 2012 KDIGO guidelines at study inception.

Results

At enrollment [median 359 d from initial biopsy], 41% patients had optimal supportive care for BP and proteinuria. Of the 59% patients with suboptimal BP and proteinuria: 7% were not on RAASi, 28% were on sub-maximal RAASi, and 24% were on maximal RAASi not at BP goal. At enrollment, only 36% incident and 45% prevalent patients had achieved optimal supportive care. Longitudinal data after initial biopsy showed > 50% participants had sub-optimal BP [≥ 125/75 mm Hg] and UPCR [≥ 1 g/g] up to 5.5 yr after diagnosis. [Figure 1]

Conclusion

Suboptimal control of BP and proteinuria was common in adults with IgAN in the 5 yr after diagnosis. Application of the more stringent 2021 KDIGO guidelines would likely indicate more at-risk patients. These findings highlight the need to continue education about the importance of conservative management. Many participants had proteinuria despite optimal BP, a group that would benefit from enrollment in clinical trials testing therapies that could mitigate disease progression.