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The Latest on X

Kidney Week

Abstract: TH-PO630

Kidney Outcomes in Self-Reported Black Patients with Primary Membranous Nephropathy in the Cure Glomerulonephropathy Study (CureGN)

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Helmuth, Margaret, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Almaani, Salem, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Ayoub, Isabelle, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Chen, Dhruti P., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Villegas, Leonela A., Connecticut Children's Medical Center, Hartford, Connecticut, United States
  • Nast, Cynthia C., Cedars-Sinai Medical Center, Los Angeles, California, United States
  • Robinson, Bruce M., University of Michigan, Ann Arbor, Michigan, United States
  • Derebail, Vimal K., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Bomback, Andrew S., Columbia University, New York, New York, United States
  • Laurin, Louis-Philippe, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada

Group or Team Name

  • Cure Glomerulonephropathy Study.
Background

Primary membranous nephropathy (pMN) is a common cause of nephrotic syndrome in adults. Disease progression in Black versus non-Black patients with pMN remains to be fully characterized.

Methods

CureGN is an ongoing multi-center prospective, observational cohort of children and adults with biopsy-proven pMN or 3 other primary glomerular diseases. First diagnostic biopsies were performed between 2010 and 2023. For this analysis, we report baseline clinical data at enrollment, proportion of time on immunosuppression during follow-up, and incident rates for kidney failure and 40% eGFR decline. Time to kidney outcomes was estimated using adjusted Cox proportional hazards models.

Results

As of May 2023, 608 pMN patients were enrolled (580 with available follow-up data). Of those, 93 were self-reported Black/African American race: median age 52 (IQR, 37-64); 39% female; and median follow-up time of 4.4 yrs. Among 444 pMN patients genetically sequenced, 12 (3%) had 2-high risk APOL1 alleles; of the 73 pMN patients with self-reported Black/African American race who were sequenced, 11 (15%) had 2-high risk APOL1 alleles.

Conclusion

In patients with pMN, self-reported Black race appears to be strongly associated with worse kidney outcomes despite having similar eGFR at enrollment. Additional analyses including assessment of genetic factors are underway to gain understanding of determinants of this observed association.

 Black (N=93)Non-Black (N=515)
Median eGFR at enrollment (mL/min/1.73m2) (IQR)76.5 (51.2-103.9)78.4 (52.6-101.0)
Median urine protein to creatinine ratio at enrollment (IQR)4.3 (1.5-8.2)2.7 (0.7-6.3)
Proportion of time on any immunosuppression during study follow up (%)2728
Kidney failure rate (per participant year)0.0530.016
eGFR decline >40% rate (per participant year)0.0820.033
Kidney outcomes (Black vs. Non-Black)HR (95% CI)p-value
Kidney Failure3.3 (1.6-6.6)0.0008
Kidney Failure & eGFR decline >40%2.4 (1.4-3.9)0.0007
Complete Remission*0.7 (0.4-1.1)0.1

All models are adjusted for sex, age at biopsy, immunosuppression use prior to biopsy, UPCR at enrollment, eGFR at enrollment and time from biopsy to enrollment. *Among those who entered the study not in complete remission. eGFR = estimated glomerular filtration rate (per CKiD-U25 if age <25 years or CKD-EPI-2021).

Funding

  • NIDDK Support