Albuminuria predicts kidney events in IgA nephropathy
Faucon, Anne Laure ; Lundberg, Sigrid ; Lando, Stefania ; Wijkström, Julia ; Segelmark, Mårten LU
; Evans, Marie
and Carrero, Juan Jesús
(2025)
In Nephrology Dialysis Transplantation
40(3).
p.465-474
- Abstract
Background and hypothesis: KDIGO recommends proteinuria <1 g/d as a treatment target in patients with immunoglobulin A nephropathy (IgAN) because of high risk of progression to kidney failure. However, long-term kidney outcomes in patients with low-grade proteinuria remain insufficiently studied. Methods: We enrolled patients with biopsy-proven primary IgAN from the Swedish Renal Registry and analyzed associations between urine albumin-to-creatinine ratio (uACR, in categories <0.3, 0.3-0.5, 0.5-1.0, 1.0-1.5, 1.5-2.0, and ≥2.0 g/g) and the occurrence of major adverse kidney events [MAKE, a composite of kidney replacement therapy (KRT) and >30% decline in estimated glomerular filtration rate (eGFR)]. We also explored the risk of... (More)
Background and hypothesis: KDIGO recommends proteinuria <1 g/d as a treatment target in patients with immunoglobulin A nephropathy (IgAN) because of high risk of progression to kidney failure. However, long-term kidney outcomes in patients with low-grade proteinuria remain insufficiently studied. Methods: We enrolled patients with biopsy-proven primary IgAN from the Swedish Renal Registry and analyzed associations between urine albumin-to-creatinine ratio (uACR, in categories <0.3, 0.3-0.5, 0.5-1.0, 1.0-1.5, 1.5-2.0, and ≥2.0 g/g) and the occurrence of major adverse kidney events [MAKE, a composite of kidney replacement therapy (KRT) and >30% decline in estimated glomerular filtration rate (eGFR)]. We also explored the risk of kidney events associated with change in uACR within a year. Results: We included 1269 IgAN patients (74% men, median 53 years, mean eGFR 33 ml/min/1.73 m², median uACR 0.7 g/g). Over a median follow-up of 5.5 [2.8; 9.2] years, 667 MAKE and 517 KRT events occurred, and 528 patients experienced >30% eGFR decline. Compared with uACR < 0.3 g/g, any higher uACR category was strongly and incrementally associated with the risk of MAKE [adjusted hazard ratios (HR) ranging from 1.56 (95%CI 1.14-2.14) if uACR 0.3-0.5 g/g to 4.53 (3.36-6.11) if uACR ≥ 2.0 g/g], KRT (HR ranging from 1.39 to 4.65), and eGFR decline >30% (HR ranging from 1.76 to 3.47). In 785 patients who had repeated uACR measurements within a year, and compared with stable uACR, the risk of kidney events was lower if uACR decreased by 2-fold (HR ranging from 0.47 to 0.49), and higher if uACR increased by 2-fold (HR from 1.18 to 2.56), irrespective of baseline uACR. Conclusions: There is substantial risk of adverse kidney outcomes among patients with IgAN and uACR between 0.3 and 1.0 g/g, a population currently considered at low risk of CKD progression. Reduction in uACR is associated with better kidney outcomes, irrespective of baseline uACR.
(Less)
- author
- Faucon, Anne Laure
; Lundberg, Sigrid
; Lando, Stefania
; Wijkström, Julia
; Segelmark, Mårten
LU
; Evans, Marie
and Carrero, Juan Jesús
- organization
- publishing date
- 2025-03
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- albuminuria, chronic kidney disease, IgA nephropathy, kidney replacement therapy
- in
- Nephrology Dialysis Transplantation
- volume
- 40
- issue
- 3
- pages
- 10 pages
- publisher
- Oxford University Press
- external identifiers
-
- pmid:38688876
- scopus:86000181110
- ISSN
- 0931-0509
- DOI
- 10.1093/ndt/gfae085
- language
- English
- LU publication?
- yes
- id
- 30eb2c93-c650-49c9-8de0-ac9d6d2b7fdd
- date added to LUP
- 2025-06-23 11:10:10
- date last changed
- 2025-07-07 11:31:56
@article{30eb2c93-c650-49c9-8de0-ac9d6d2b7fdd,
abstract = {{<p>Background and hypothesis: KDIGO recommends proteinuria <1 g/d as a treatment target in patients with immunoglobulin A nephropathy (IgAN) because of high risk of progression to kidney failure. However, long-term kidney outcomes in patients with low-grade proteinuria remain insufficiently studied. Methods: We enrolled patients with biopsy-proven primary IgAN from the Swedish Renal Registry and analyzed associations between urine albumin-to-creatinine ratio (uACR, in categories <0.3, 0.3-0.5, 0.5-1.0, 1.0-1.5, 1.5-2.0, and ≥2.0 g/g) and the occurrence of major adverse kidney events [MAKE, a composite of kidney replacement therapy (KRT) and >30% decline in estimated glomerular filtration rate (eGFR)]. We also explored the risk of kidney events associated with change in uACR within a year. Results: We included 1269 IgAN patients (74% men, median 53 years, mean eGFR 33 ml/min/1.73 m², median uACR 0.7 g/g). Over a median follow-up of 5.5 [2.8; 9.2] years, 667 MAKE and 517 KRT events occurred, and 528 patients experienced >30% eGFR decline. Compared with uACR < 0.3 g/g, any higher uACR category was strongly and incrementally associated with the risk of MAKE [adjusted hazard ratios (HR) ranging from 1.56 (95%CI 1.14-2.14) if uACR 0.3-0.5 g/g to 4.53 (3.36-6.11) if uACR ≥ 2.0 g/g], KRT (HR ranging from 1.39 to 4.65), and eGFR decline >30% (HR ranging from 1.76 to 3.47). In 785 patients who had repeated uACR measurements within a year, and compared with stable uACR, the risk of kidney events was lower if uACR decreased by 2-fold (HR ranging from 0.47 to 0.49), and higher if uACR increased by 2-fold (HR from 1.18 to 2.56), irrespective of baseline uACR. Conclusions: There is substantial risk of adverse kidney outcomes among patients with IgAN and uACR between 0.3 and 1.0 g/g, a population currently considered at low risk of CKD progression. Reduction in uACR is associated with better kidney outcomes, irrespective of baseline uACR.</p>}},
author = {{Faucon, Anne Laure and Lundberg, Sigrid and Lando, Stefania and Wijkström, Julia and Segelmark, Mårten and Evans, Marie and Carrero, Juan Jesús}},
issn = {{0931-0509}},
keywords = {{albuminuria; chronic kidney disease; IgA nephropathy; kidney replacement therapy}},
language = {{eng}},
number = {{3}},
pages = {{465--474}},
publisher = {{Oxford University Press}},
series = {{Nephrology Dialysis Transplantation}},
title = {{Albuminuria predicts kidney events in IgA nephropathy}},
url = {{http://dx.doi.org/10.1093/ndt/gfae085}},
doi = {{10.1093/ndt/gfae085}},
volume = {{40}},
year = {{2025}},
}