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Abstract: SA-PO914

Impact of Time to Treatment on Outcomes in Primary Membranous Nephropathy

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Hamilton, Patrick, Manchester University NHS Foundation Trust, Manchester, United Kingdom
  • Bate, Sebastian G., Manchester University NHS Foundation Trust, Manchester, United Kingdom
  • Ragy, Omar Sherin, Manchester University NHS Foundation Trust, Manchester, United Kingdom
  • Hiremath, Mrityunjay, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
  • Rao, Anirudh, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
  • Khwaja, Arif, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, Sheffield, United Kingdom
  • Kanigicherla, Durga Anil K, Manchester University NHS Foundation Trust, Manchester, United Kingdom
Background

Despite treatment, progression of renal dysfunction remains a significant burden globally in patients with primary MN (pMN). Clinicians use individualized risk assessment to choose immunosuppression therapy after ‘watchful wait’ to help avoid side-effects in those who could otherwise have achieved remission spontaneously. Here we describe features of renal disease during the ‘watchful wait’ period and its association with longer term outcomes.

Methods

Retrospective longitudinal cohort study of patients with pMN (biopsy-proven or positive serology in the absence of secondary causes). Data collected from three specialist centres in the North of England, with patients presenting as proteinuric kidney disease from Jan 2003 to July 2019, with follow-up data to Sept 2021. Risk markers included uPCR, eGFR and baseline demographic factors. Primary outcomes were CKD5 and Partial Remission (PR). Secondary outcomes were Progression (composite of doubling of creatinine, CKD5, and death). Analysis investigated the change in eGFR based on risk categorisation. Cox proportional hazard models were used to assess the association of outcomes with risk markers.

Results

312 patients were included. Using eGFR and uPCR, patients in the low and moderate risk groups were more likely to achieve spontaneous PR (Fig 1A). The strongest predictor of renal outcome was eGFR at the start of immunosuppression (IS), irrespective of baseline function, and the longer patients waited to start treatment, the worse the renal decline (Fig 1B).

Conclusion

Combined eGFR and uPCR can be used to predict patients who are more likely to attain SR and that in patients who require IS, the longer it takes to initiate treatment, the worse their renal outcomes. This has significant implications for future guidelines in the management of pMN.

A) eGFR & uPCR at baseline and first key outcome B) Percent change in eGFR between baseline and start of IS Low:uPCR<350 & eGFR>60; Mod 1:350≤uPCR<600 & eGFR>60; Mod 2:uPCR≥600 & eGFR≥60; High 1:300≤uPCR<600 & eGFR<60; High 2:uPCR≥600 & eGFR<60; SPR: Spontaneous PR; IPR: PR with IS; uPCR - mg/mmol; eGFR - ml/min