Kidney Week

Abstract: TH-PO1260

Relationship Between Proteinuria Reduction and Preservation of GFR in Patients with IgA Nephropathy

Session Information

• Late-Breaking Research Posters
  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

• Beal, Bryony A., The George Institute for Global Health, Sydney, New South Wales, Australia

Bryony A. Beal, MBBS

• Fletcher, Robert A., The George Institute for Global Health, Sydney, New South Wales, Australia

Robert A. Fletcher, MSc

• Perkovic, Vlado, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia

Vlado Perkovic, MBBS, PhD, FASN

• Barratt, Jonathan, University of Leicester, Leicester, England, United Kingdom

Jonathan Barratt, MBChB, PhD

• Cheung, Chee Kay, University of Leicester, Leicester, England, United Kingdom

Chee Kay Cheung, MBChB, PhD

• Heerspink, Hiddo Jan L., Universitair Medisch Centrum Groningen, Groningen, GR, Netherlands

Hiddo Jan L. Heerspink, PharmD, PhD

• Jardine, Meg, NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia

Meg Jardine, MBBS, PhD

• Kim, Dana, University of Sydney, Sydney, New South Wales, Australia

Dana Kim, MBBS

• Lv, Jicheng, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China

Jicheng Lv, MD

• Reich, Heather N., Toronto General Hospital, Toronto, Ontario, Canada

Heather N. Reich, MD, PhD

• Rizk, Dana V., University of Alabama at Birmingham Health System, Birmingham, Alabama, United States

Dana V. Rizk, MD

• Rovin, Brad, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

Brad Rovin, MD, FASN

• Wong, Muh Geot, University of Sydney, Sydney, New South Wales, Australia

Muh Geot Wong, MBBS, PhD

• Zhang, Hong, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China

Hong Zhang, MD, PhD

• Neuen, Brendon Lange, The George Institute for Global Health, Sydney, New South Wales, Australia

Brendon Lange Neuen, MBBS, MS, PhD, FASN

Background

Several therapies with varying mechanisms of action have been shown to reduce proteinuria and glomerular filtration rate (GFR) decline in IgAN. Whether the relationship between proteinuria reduction and GFR preservation differs between immune and non-immune therapies is unknown.

Methods

We performed a meta-analysis of randomised controlled trials in IgAN reporting effects on proteinuria and GFR slope with ≥100 patient-years follow-up. Trial-level mixed-effects meta-regression was used to evaluate the relationship between treatment effects on proteinuria and GFR slope.

Results

16 trials involving 4838 participants with IgAN were included, with 9 immune and 7 non-immune trials. Therapies that reduced proteinuria also generally attenuated GFR slope, although magnitude of benefit varied (Figure 1A). In stratified analyses, the relationship between proteinuria reduction and GFR slope appeared to differ qualitatively between immune and non-immune therapies, although the interaction was not statistically significant (P-interaction=0.171; Figure 1B). Immune therapies were associated with a 38.3% (95% CI 11.5-65.1) greater relative effect on GFR slope than non-immune therapies for equivalent reductions in proteinuria (P=0.009; Figure 1C). Therapeutic mechanism alone explained a substantial proportion of between-trial heterogeneity (R2=62.1%), whereas proteinuria reduction was not associated with treatment effects on GFR slope after accounting for therapeutic mechanism (P=0.979).

Conclusion

In IgAN, immune therapies were associated with greater preservation of GFR than non-immune therapies for equivalent reductions in proteinuria. These findings suggest proteinuria alone may not fully capture treatment-related kidney protection and support consideration of therapeutic mechanism when selecting and sequencing therapies in IgAN.