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Kidney Week

Abstract: SA-PO950

Application of Prediction Tools in Patients with IgA Nephropathy: A Single-Center Cohort

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Agapito Fonseca, José, Serviço de Nefrologia e Tranplantação e Renal, Hospital de Santa Maria, Centro Hospitalar e Universitário Lisboa Norte, Lisboa, Portugal
  • Riesenberger, João, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
  • Godinho, Iolanda, Serviço de Nefrologia e Tranplantação e Renal, Hospital de Santa Maria, Centro Hospitalar e Universitário Lisboa Norte, Lisboa, Portugal
  • Pereira, Marta, Serviço de Nefrologia e Tranplantação e Renal, Hospital de Santa Maria, Centro Hospitalar e Universitário Lisboa Norte, Lisboa, Portugal
  • Lopes, Jose António, Serviço de Nefrologia e Tranplantação e Renal, Hospital de Santa Maria, Centro Hospitalar e Universitário Lisboa Norte, Lisboa, Portugal
  • Gameiro, Joana, Serviço de Nefrologia e Tranplantação e Renal, Hospital de Santa Maria, Centro Hospitalar e Universitário Lisboa Norte, Lisboa, Portugal
Background

IgA nephropathy (IgAN) is the most common glomerular disease. Despite the development of prognostic scores, such as then IgAN Prediction Tool (IgAN-PT), long-term clinical course is difficult to predict. The Kidney Risk Failure Equation (KFRE) is a four-variable equacionar which allows to predict the two and five-year probability of requiring kidney replacement therapy (KRT), but its accuracy on IgAN has not been established. The aim of this study was to assess the discriminative ability of the KFRE compared to the IgAN-PT to predict KRT in patients with IgAN.

Methods

We conducted a retrospective analysis of patients with IgAN followed by the Nephrology and Kidney Transplantation Department in Centro Hospitalar Universitário Lisboa Norte for five years. The primary outcome was the need for KRT within five years after kidney biopsy. The IgAN-PT and the four-variable KFRE were calculated for multiple follow-up points.

Results

Twenty-nine patients were included and 58.6% were male. At presentation, mean age was 41.3 ± 13.6 years, serum creatinine was 1.60 ± 1.17 mg/dL, and proteinuria was 1360 ± 1120 mg/g. At biopsy, the five-year KFRE score was 13.9 ± 25.6% and the five-year IgAN-PT score was 14.7 ± 15.9%. Three patients started KRT (10.3%) during follow-up. Proteinuria at presentation (3032 mg/g vs. 1159 mg/g, p=0.004) and serum creatinine on kidney biopsy (2.81 mg/dL vs. 1.35 mg/dL, p=0.003) were associated with need for KRT. Both the IgAN-PT and the KFRE correctly identified patients with higher risk for KRT, with the KFRE equation at clinical presentation exhibiting a slight superiority over the IgAN-PT (AUC 0.885 vs. 0.846).

Conclusion

The KFRE score at five-years after clinical presentation in patients with IgAN has shown excellent discriminative ability for identifying patients at risk of KRT. Moreover, it has demonstrated equivalent accuracy compared to the more specific IgAN-PT, being easier to apply and allowing for longer-term prognosis.