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Kidney Week

Abstract: TH-PO615

ESKD and CKD Progression Among a Diverse Immunoglobulin A Nephropathy (IgAN) Population

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Sim, John J., Kaiser Permanente Southern California, Pasadena, California, United States
  • Chen, Qiaoling, Kaiser Permanente Southern California, Pasadena, California, United States
  • Chang, John M., Kaiser Permanente Southern California, Pasadena, California, United States
  • Cannizzaro, Nancy, Kaiser Permanente Southern California, Pasadena, California, United States
  • Makhija, Dilip, Otsuka America Pharmaceutical Inc, Rockville, Maryland, United States
  • Bhattacharjee, Sandipan, Otsuka America Pharmaceutical Inc, Rockville, Maryland, United States
  • Fernandes, Ancilla, Otsuka America Pharmaceutical Inc, Rockville, Maryland, United States
  • Pinto, Cibele S., Otsuka America Pharmaceutical Inc, Rockville, Maryland, United States
  • Schachter, Asher Daniel, Visterra Inc, Waltham, Massachusetts, United States
  • Mathur, Mohit, Visterra Inc, Waltham, Massachusetts, United States
Background

IgAN is the most common glomerulonephritis and a leading cause of ESKD but real-world data on natural history of the disease are sparse. This study evaluated kidney outcomes among a diverse IgAN population in an integrated US health system.

Methods

Longitudinal cohort study (1/1/2000-12/31/2021) was performed within Kaiser Permanente Southern California members with biopsy proven primary IgAN. Secondary IgAN was excluded. Kidney outcome was a composite of ESKD (dialysis or transplant) and/or CKD progression. Patients were followed from index biopsy until kidney outcome and censored for mortality, disenrollment, or end of study. Multivariable Cox regression was used to estimate hazard ratios (HR).

Results

Among 687 patients with IgAN, mean age was 45.5 (SD 14.7) yrs. with 52% males, 40% Hispanic/Latino, 30% Asian/Pacific Islander, 24% White, 3% Black, and 39% with eGFR<45). At biopsy, mean eGFR was 58 and mean urine protein creatinine ratio (uPCR) was 2.5 g/g. A total of 270 (39%) had a kidney outcome (39 ESKD, 231 CKD progression) with median time to outcome of 1.3 years (2.4 years among eGFR>30 patients). Median time to ESKD was 2.6 years (4.7 years among eGFR>30 patients). The composite kidney outcome rate was 96.8 (per 1,000 person-years) without significant influence of race/ethnicity. ESKD incidence rate was 56.1 (per 1,000 person-years), also without significant influence of race/ethnicity over the median follow-up duration of 3.4 years. Baseline eGFR, male sex, hypertension, diabetes, hematuria, and age>65, were identified as predictors of ESKD and CKD progression.

Conclusion

Among a diverse IgAN population within a real-world environment, we observed a high rate of kidney outcomes in patients with lower eGFR and hypertension, but no difference across race/ethnic groups. Additional analysis evaluating effect of uPCR and treatment on kidney outcomes is ongoing.