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Abstract: FR-PO658

Practice Patterns in IgA Nephropathy: A Questionnaire-Based Survey

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Bansal, Bhavik, Medical Student, All India Institute of Medical Sciences, New Delhi, New Delhi, Delhi, India
  • Grewal, Amritesh, Medical Student, All India Institute of Medical Sciences, New Delhi, New Delhi, Delhi, India
  • Trimarchi, Hernan, Nephrology Service, Hospital Británico Buenos Aires Argentina, Buenos Aires, Argentina
  • Teo, Boon Wee, Division of Nephrology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore
  • Shima, Yuko, Pediatrics, Wakayama Medical University, Japan, Wakayama, Japan
  • Sundaram, Madhivanan, Department of Nephrology, Royal Darwin Hospital, Darwin, Australia, Darwin, Northern Territory, Australia
  • He, Haidong, Division of Nephrology, Fudan University, Minhang Hospital, Shanghai, China, Shanghai, China
  • Subbiah, Arunkumar, Nephrology Department, All India Institute of Medical Sciences, New Delhi, India, New Delhi, Delhi, India
  • Bhowmik, Dipankar M., Nephrology Department, All India Institute of Medical Sciences, New Delhi, India, New Delhi, Delhi, India
  • Agarwal, Sanjay K., Nephrology Department, All India Institute of Medical Sciences, New Delhi, India, New Delhi, Delhi, India
  • Bagchi, Soumita, Nephrology Department, All India Institute of Medical Sciences, New Delhi, India, New Delhi, Delhi, India
Background

IgA nephropathy (IgAN) is a common primary glomerular disease with ethnic differences in phenotype. The Kidney Disease Improving Global Outcomes (KDIGO) has provided guidelines for management of IgAN but the actual practice patterns among nephrologists is not known.

Methods

An online questionnaire-based survey was conducted focussing on treatment strategies practiced by nephrologists in management of IgAN.

Results

Among 402 responders, 76.9% treat adults, 9.2% paediatric patients and 13.9% both. 61.2% respondents were from Asia, 18.4% from South America, 9.7% from North America, 7.2% from Europe and 3.5% from Australia. MEST-C score was not reported in 12.7% centres, mainly in Australia (28.6%) and South America (23.0%).
97% nephrologists use initial supportive therapy by renin angiotensin system (RAS) blockade with ACEi /ARB; ramipril (20.8%) and losartan (23.6%) being most preferred. Also, 26.1% use dual RAS blockade and 56.7% aldosterone blockers. Other treatments used are fish oil (45.0%), SGLT-2 inhibitors (49.5%) and hydroxychloroquine (13.4%). Though 59.5% target blood pressure <130/80 mm Hg, 37.1% target < 120/80 mm Hg. Most nephrologists wait 3-6 months (42.4%) or >6 months (26.6%) before starting immunosuppression.
For starting immunosuppression, 92.8% consider degree of proteinuria, 79.1% eGFR and 65.7% MEST-C score. 40.6% start immunosuppression immediately if proteinuria is >3g/day. 31.1% use immunosuppression in non-crescentic IgAN with eGFR< 30 ml/min/1.73m2.
89.1% use steroids as first line immunosuppression, while 6.5% use mycophenolate mofetil (MMF). 86.6% use second line immunosuppression in steroid resistant patients, MMF (50%) being most commonly prescribed. 99.2% use immunosuppression for C2 lesions: steroids + cyclophosphamide is the most commonly used regimen (66.7%). 43.5% use immunosuppression in all cases with C1 lesions, 47% individualize therapy based on eGFR and proteinuria while 9.5% do not use immunosuppression.

Conclusion

Although most nephrologists agree on the parameters to assess disease status, there is heterogeneity in type of supportive therapy and immunosuppression used especially in difficult to treat cases.