Kidney Week

Abstract: TH-PO634

A Nomogram Prediction Model for Treatment Failure in Primary Membranous Nephropathy

Session Information

• Glomerular Diseases: Clinical and Epidemiologic Studies
  November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

• Geng, Chanyu, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, China

Chanyu Geng,

• Feng, Yunlin, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China

Yunlin Feng,

Background

The natural course of primary membranous nephropathy (PMN) is heterogeneous. Immunosuppressive therapy is recommended to PMN patients at risk for renal function deterioration. Prediction model for treatment failure of PMN has been rarely reported.

Methods

This study retrospectively included PMN patients diagnosed by renal biopsy in Sichuan Provincial People's Hospital from January 2017 to December 2020. Information of clinical characteristics, laboratory test, pathological examination, and treatment was collected. The outcome was treatment failure at the end of twelve months. Simple logistic regression was used to identify candidate predictive variables. Forced-entry stepwise multivariable logistic regression was used to develop the prediction model, of which the performance was evaluated using AUC, calibration plot, and DCA analysis. Internal validation was performed using bootstrapping method.

Results

A total of 310 patients were recruited in this study. The comorbidity rates of hypertension and diabetes were 37% (112/310) and 11% (33/310), respectively. At renal biopsy, the medium levels of eGFR, serum creatinine, serum albumin, proteinuria and PLA₂R antibody were 102.3 ml/min/1.73m², 70.1 µmol/L, 24.3 g/L, 5.9 g, and 35.48 RU/ml. 116 patients achieved the outcome. Forced-entry stepwise multivariable logistic regression indicated that PLA₂R antibody (OR=1.002, 95%CI: 1.001-1.003, P=0.002), renal interstitial inflammatory cells infiltration (OR=1.935, 95%CI: 1.393-2.478, P=0.017), and C3 deposit on immunofluorescence (OR=0.294, 95%CI: -0.928-1.515, P=0.049) were the three independent risk factors for treatment failure of PMN. The final prediction model has an AUC (95% CI) of 0.653(0.590-0.717) and a net benefit in the range of 23%-77%.

Conclusion

PLA₂R antibody, renal interstitial inflammatory cells infiltration, and C3 deposit on immunofluorescence were the three independent risk factors for treatment failure at 12 months in PMN. Our prediction model may help to identify patients with risk of treatment failure thus avoid unnecessary drug exposure and side effects.