Abstract: TH-PO0491
Treatment Patterns and Outcomes in IgAN: An Artificial Intelligence (AI)-Enabled Analysis of 480 Patients at a Large Community Practice
Session Information
- Glomerular Diseases: Clinical, Outcomes, and Therapeutics Research - IgAN
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Hariharan, Sanjay, Century Health, New York, New York, United States
- Srivastava, Vish, Century Health, New York, New York, United States
- Behrend, Terry L., San Diego Vascular Access Center, San Diego, California, United States
- Radhakrishnan, Jai, Columbia University Medical Center, New York, New York, United States
Background
The IgAN treatment landscape has been transformed by novel agents, alongside SGLT2 inhibitors, with additional approvals expected this year. While 2025 KDIGO guidelines endorse a more aggressive treatment paradigm, real-world adoption in US community nephrology remains poorly characterized.
Methods
Longitudinal cohort of 480 IgAN patients at a large Southern California community practice. From 81,183 CKD patients, the Century Health Abstraction & Retrieval Model (CHARM) identified 1,081 biopsy-confirmed candidates; 237 on dialysis, 88 post-transplant, and 276 with insufficient longitudinal data (<3 eGFR and <3 UPCR/UACR) were excluded. Initial values anchored ±90 days of drug start. Novel agents: budesonide, sparsentan, atrasentan, iptacopan. Slopes calculated by per-patient OLS (≥3 points, 1.5×IQR trim).
Results
Median age 62; 54.6% female; 26.9% Hispanic/Latino; 38.1% White, 18.1% Asian. Median follow-up 4.9 yr. Exposure: RAASi 91.5%, SGLT2i 47.9%, budesonide 7.9%, sparsentan 2.1%, atrasentan 0.2%. Novel-agent initiation rose 1.1-fold post-KDIGO 2025.
Budesonide showed less negative eGFR slope vs RAASi only (p=0.007, Mann-Whitney). Table and Kalpan-Meier curve shows clear gradient from RAASi -> SGLT2 -> Budesonide for all outcomes. Higher baseline UPCR/UACR in budesonide patients suggests selection toward more aggressive disease.
Conclusion
This is among the first characterizations of contemporary IgAN care in US community nephrology during the novel-agent era. With sparsentan, atrasentan, and iptacopan recently appearing in the data, this cohort is well-positioned to track the evolving IgAN landscape.
Results Per Therapy
| Cohort | # Patients | Initial eGFR | Initial UPCR | Initial UACR | eGFR Slope (/yr) | eGFR 50% of Initial (%/yr) | UPCR/UACR 50% of Initial (%/yr) |
| All Patients | 480 | 54 | 0.83 | 0.37 | -2.25 | 3.25 | 12.83 |
| RAASi only | 207 | 63 | 0.92 | 0.35 | -2.22 | 3.48 | 12.25 |
| RAASi + SGLT2i | 187 | 52.5 | 0.81 | 0.59 | -2.14 | 3.1 | 12.73 |
| Budesonide | 34 | 49 | 1.69 | 1.04 | +0.21 | 2.95 | 23.64 |
Median values shown for initial eGFR, UPCR, UACR %/yr is normalized by years of follow up