Abstract: FR-PO657
Prevalence of Optimal Conservative Therapy Implementation Among CureGN Participants With IgA Nephropathy
Session Information
- Glomerular Diseases: Clinical, Outcomes, Trials - II
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
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.