Kidney Week

Abstract: FR-PO0869

Attribute-Based Medicine for IgAN: A Nationwide Japanese Cohort Reveals Prognostic Interactions

Session Information

• Glomerular Outcomes: From Proteinuria to Prognosis
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Kataoka, Hiroshi, Tokyo Joshi Ika Daigaku, Shinjuku, Tokyo, Japan

Hiroshi Kataoka

• Manabe, Shun, Tokyo Joshi Ika Daigaku, Shinjuku, Tokyo, Japan

Shun Manabe, MD, PhD

• Moriyama, Takahito, Tokyo Ika Daigaku, Shinjuku, Tokyo, Japan

Takahito Moriyama, MD, PhD

• Ushio, Yusuke, Tokyo Joshi Ika Daigaku, Shinjuku, Tokyo, Japan

Yusuke Ushio, MD, PhD

• Nitta, Kosaku, Tokyo Joshi Ika Daigaku, Shinjuku, Tokyo, Japan

Kosaku Nitta

• Hoshino, Junichi, Tokyo Joshi Ika Daigaku, Shinjuku, Tokyo, Japan

Junichi Hoshino, MD, PhD, MPH

• Hirano, Keita, Tokyo Jikeikai Ika Daigaku, Minato, Tokyo, Japan

Keita Hirano, MD, PhD

• Matsuzaki, Keiichi, Kitasato Daigaku Igakubu, Sagamihara, Kanagawa Prefecture, Japan

Keiichi Matsuzaki, MD, PhD

• Yasuda, Takashi, Nagoya Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Nagoya, Aichi Prefecture, Japan

Takashi Yasuda, MD, PhD

• Yasuda, Yoshinari, Kichijoji Asahi Byoin, Musashino, Tokyo, Japan

Yoshinari Yasuda, MD, PhD

• Kawamura, Tetsuya, Tokyo Jikeikai Ika Daigaku, Minato, Tokyo, Japan

Tetsuya Kawamura, MD, PhD

• Maruyama, Shoichi, Nagoya Daigaku, Nagoya, Aichi Prefecture, Japan

Shoichi Maruyama, MD, PhD

• Yokoo, Takashi, Tokyo Jikeikai Ika Daigaku, Minato, Tokyo, Japan

Takashi Yokoo, MD, PhD

• Suzuki, Yusuke, Juntendo Daigaku, Bunkyo, Tokyo, Japan

Yusuke Suzuki, MD, PhD

Background

IgA nephropathy (IgAN) is a heterogeneous glomerular disease with variable progression patterns. Attribute-based medicine emphasizes tailoring treatment to individual characteristics. We hypothesized that this approach could clarify residual risks and inform personalized management.

Methods

This secondary analysis included 996 adults from the Japanese Nationwide Retrospective Cohort Study in IgAN. The primary outcome was kidney replacement therapy or a ≥1.5-fold increase in serum creatinine. Six attributes were assessed: age, sex, BMI, CKD stage, urinary protein excretion (U-Prot), and urine occult blood (U-OB). Cox regression and Kaplan–Meier analyses evaluated main effects and interactions with eight clinical variables (e.g., eGFR, corticosteroid use, hyperuricaemia).

Results

Over a median 7.0 years, 111 patients (11.1%) reached the primary outcome. Multivariable analysis identified low eGFR (HR=0.87 per 10 mL/min/1.73 m²), high U-Prot (log HR=4.54), and hyperuricaemia (HR=1.64) as risk factors; corticosteroids (HR=0.60) and tonsillectomy (HR=0.44) were protective. Key interactions included:
1. Hyperuricaemia with BMI <22 kg/m² (HR=3.44, P=0.003),
2. Hypertension with female sex (HR=4.36, P=0.018),
3. The prognostic impact of age and eGFR differed between CKD stage 3 and stages 1–2, indicating a reversal in risk association,
4. Stronger association of U-Prot with outcomes in those with U-OB ≤2+,
5. Corticosteroids improved outcomes in patients with U-Prot ≥1 g/day, while tonsillectomy was most effective in those with U-OB ≥3+.

Conclusion

Attribute-based analysis uncovered critical risk modifiers and supports individualized treatment strategies in IgAN. This approach enables precision nephrology and may improve kidney outcomes by aligning therapy with patient attributes.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025tqd18tnc