Abstract: FR-PO0724
High Adherence to Angiotensin-Converting Enzyme Inhibitor in Children with Alport Syndrome: Objective Verification Using Liquid Chromatography Mass Spectrometry
Session Information
- Pediatric Nephrology: CKD, ESKD, and Glomerular Diseases
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Boeckhaus, Jan, Universitatsmedizin Gottingen, Göttingen, Germany
- Gross, Oliver, Universitatsmedizin Gottingen, Göttingen, Germany
Background
Kidney failure (KF) in children and adolescents leads to reduced lifespan and compromised health. Alport syndrome (AS) is the second common genetic cause of KF. Angiotensin-converting enzyme inhibitors (ACEi) have demonstrated efficacy in delaying KF in young people living with AS, but non-adherence can compromise their therapeutic benefits. To investigate the adherence to ACEi in children and adolescents with AS, a liquid chromatography mass spectrometry (LCMS) based method was developed for objective verification of medication intake.
Methods
Urine samples from 58 children enrolled in the EARLY PRO-TECT Alport trial were analyzed. A LCMS based method was established and validated to simultaneously screen and quantify both ramipril and ramiprilat in urine samples. Participants were not informed in advance of the adherence measurements.
Results
109 urine samples from patients with early stages of chronic kidney disease (mean estimated glomerular filtration rate: 130 ± 32 ml/min/1.73m) were analyzed at two different time points. All 13 negative control samples (100%) were identified correctly. Adherence to ACEi therapy was consistently high, with 98% of children showing confirmed drug intake at both the initial (48/49) and second (44/45) measurements.
Conclusion
This study demonstrated that children with chronic kidney disease, when treated with ACEi within a clinical trial, maintain a high adherence to the prescribed medication.
Figure 1: Illustration of adherence to RASi. Donut graphs show the proportion of (A) the overall cohort of 107 measurements, including 13 negative controls (B) correctly identified negative controls (n=13, 100%). (C) adherence and non-adherence at both time points of the study (n=94; 98% adherence), (D) adherence and non-adherence at first adherence measurement (n=49; 98% adherence), (E) adherence and non-adherence at the second adherence measurement (n=45; 98% adherence)
Funding
- Government Support – Non-U.S.