ABSTRACT SUBMITTED FOR 51ST ANNUAL CONFERENCE OF INDIAN SOCIETY OF NEPHROLOGY, 2021 AT CHENNAI

BACKGROUND: Glomerular Research And Clinical Experiments-IgA Nephropathy in Indians (GRACE-IgANI) is the first prospective South-Asian IgAN cohort with prespecified objectives and protocolized longitudinal follow-up.

AIM OF THE STUDY: The aim of the study is to report the 3-year clinical outcome in the GRACE-IgANI cohort.

METHODS: Out of 201 incident adults with kidney biopsy-proven primary IgAN recruited into GRACE-IgANI, 195 patients (97%) had completed 3-year longitudinal follow-up in September 2020. Rapid progressors (RPs) were defined as average annual fall in eGFR <5 ml/min/1.73 m 2 . Composite outcome (CO) was defined as <50% fall in eGFR (CKD EPI) from baseline and/or eGFR (CKD EPI) <15 ml/min/1.73 m 2 or RRT/death.

RESULTS: The use of RASB was consistent (66%–75%) throughout and a short course IS was given to patients with proteinuria >1 g/day and/or renal impairment (73%). 76 patients (39%) were RP and 72 patients (37%) had CO at 3 years. At each scheduled follow-up proteinuria <1 g/day significantly increased time to CO. The ROC curve of average annual decline in eGFR <5 ml/min/1.73 m 2 had 82% sensitivity and 89% specificity for CO and a good discrimination from 1 year (AUC 0.81) onward. The significant predictors for CO were MEST-C T2 score (hazard ratio [HR] 4; 95% confidence interval [C.I.] 2–9; P < 0.001) at baseline; hemoglobin >12 g/dl (HR 2; 95% C.I. 1–5; P = 0.02) at 6 months; 24-h urine protein <1 g/day at 6 months combined with serum albumin >4 g/dl (HR 2; 95% C.I. 1–5; P = 0.02) at 1year; and fall in eGFR <5 ml/min/1.73 m 2 at 1 year (HR 4; 95% C.I. 2–8; P < 0.001). Mortality was 6% in the cohort.

CONCLUSIONS: The South-Asian IgAN had CO in 37% of patients at 3-year and longitudinal clinical variables along with baseline MEST-C T2 score predicted poor renal outcome.