Lower eGFR Research Articles

Evaluation of kidney function and body composition in adult survivors of unilateral, non-metastatic, non-syndromic Wilms tumor: A report from the St. Jude Lifetime Cohort Study.

10064 Background: The relationships among treatment exposures, body composition and estimated glomerular filtration rate (eGFR) in adult survivors of childhood have not been well studied. Methods: We evaluated body composition with dual energy x-ray absorptiometry (DXA) and eGFR with the Kidney Disease International Global Outcomes (KDIGO) 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD) in 149 adults previously treated for non-syndromic, non-metastatic, unilateral Wilms tumor at St. Jude Children’s Research Hospital between 1964 and 2004 with chemotherapy and with [(whole abdomen (WA) radiation therapy (RT) – 41 patients; median dose 12.5 Gray (Gy), Interquartile Range (IQR) 12.5 – 20.0 Gy); (hemiabdomen (HA) RT – 30 patients; median dose 12.0 Gy, IQR 10.8 – 20.1 Gy)] or without (78 patients) RT. z-scores for DXA variables were calculated using data from the National Health and Nutrition Survey (1). Results: The study population [56 males (37.6%), 109 whites (73.2%)] was a median of 3.1 years of age at diagnosis (IQR: 1.7-4.3) and 23.4 years at evaluation (IQR: 23.4-35.5). Relative total and relative trunk lean mass, and eGFR were significantly decreased among those who received WART compared to unirradiated patients. Linear regression demonstrated that WART was significantly associated with a lower eGFR (p = 0.012) and higher value of creatinine (p = 0.013). Conclusions: Relative total and relative trunk lean mass, and eGFR are decreased in survivors of unilateral, non-metastatic, non-syndromic WT following WART. Although eGFR was in the normal range, eGFR may be inaccurate due to loss of lean mass. Assessments using non-secreted molecules may more accurately measure the magnitude of kidney function loss among WART treated WT survivors. 1. PLoS ONE 2009;4(9):e7038. [Table: see text]

Incidence and risk factors of acute kidney injury after transcatheter aorticvalve replacement.

Acute kidney injury (AKI) is a common early complication secondary to transcatheter aortic valve replacement (TAVR). Studies on the incidence and risk factors for AKI after TAVR surgery are limited to date. Here, we retrospectively analyzed the incidence and risk factors for AKI after TAVR surgery in our hospital. Patients who underwent TAVR surgery at our hospital from November 2017 to February 2023 were selected. AKI was defined using the 2012 KDIGO definition and staging criteria. The relevant data and information between the AKI group and the non-AKI group were compared and analyzed, and a binary logistic regression model was used to analyze the risk factors for AKI. A total of 75 patients who underwent TAVR surgery were included in the retrospective analysis. After TAVR, the incidence of AKI was 17.3% (13/75), of which 8 (61.5%) had stage 1 AKI, 2 (15.4%) had stage 2 AKI, 3 (23.1%) had stage 3 AKI, and 3 needed renal replacement therapy. After multivariate logistic analysis, contrast volume (OR = 1.024 (1.001, 1.047)) was found to be an independent risk factor for AKI, while patients with high estimated glomerular filtration rate (eGFR) (OR = 0.903 (0.826, 0.986)) have a reduced risk of AKI. A retrospective study revealed a 17.3% incidence of AKI after TAVR surgery in our hospital, most of which were stage 1 AKI. A low preoperative eGFR and contrast volume were found to be independent risk factors for AKI.

Determinants of 1-year mortality after acute myocardial infarction in patients with and without diabetes

The gap in excess mortality between patients with and without diabetes has not decreased over time. The aim of this study was to investigate the determinants of mortality after acute myocardial infarction (AMI) in patients with diabetes and without diabetes in a contemporary population. A retrospective analysis of a cohort of 266 patients with a diagnosis of AMI during 2022 was carried out. Patients living with diabetes had higher 1-year mortality, even after adjustment for covariates. Estimated glomerular filtration (eGFR) rate was independently associated with increased mortality in patients with diabetes. Plasma glucose was independently associated with peak troponin in patients both with and without diabetes. These data suggest that patients living with diabetes and with a low eGFR warrant more aggressive risk reduction and use of nephroprotective medications. Further studies are needed to assess whether early blood glucose control improves cardiovascular outcomes in all patients with AMI.

Prevalence and risk factors for chronic kidney disease of unknown aetiology (CKDu) among industrial workers

Objectives Industrial workers are facing an occurrence of high risk factors. Exploring the frequency of CKDu and associated risk factors in industrial workers is needed. This study examined the CKDu prevalence and associated risk factors in industrial workers. Design: Cross section study. Material and Methods We enrolled 134 (83 male and 41 female) industrial workers. Modifying diet in renal disease (MDRD) equation was used to determine the estimated glomerular filtration rate (eGFR). The CKDu stages 1–5 were assessed using Kidney Disease: Improving Global Outcomes (KIDGO) guidelines. Results The mean eGFR was reported to be 99.2 for male workers and 85.2 ml/min per 1.73 m2 for female workers. The average eGFR among male workers was higher than female workers. 43.3% of workers had normal eGFR (> 90), while 52.2% of workers had a mild reduction (89–60), and 4.5% of workers had a moderate loss (59–45). No cases of severe loss and kidney failure (< 15) were noted. CKDu stage 2 was significantly higher in female workers than male workers. The increased odds ratio (OR) of CKDu stage 3 (< 60) was noted among male workers, with an increase in age, overweight, obesity, hypertension, diabetes, habits of smoking, and alcohol consumption. Conclusion The present study noted a lower eGFR and a higher OR of CKDu in industrial workers with risk factors. To avoid the progression from moderate severe loss and kidney failure, suggested weight reduction, avoiding smoking and alcohol consumption, and controlling diabetes and hypertension.

Incidence and Risk Factors for Hyponatremia in Postoperative Spinal Surgery Patients.

The incidence of hyponatremia after orthopedic surgery is high. Hyponatremia may prolong hospitalization and increase mortality, but few reports have identified risk factors for hyponatremia after spinal surgery. This study aims to determine the incidence and risk factors for hyponatremia after spinal surgery. A total of 200 patients aged 20 years or older who underwent spinal surgery at our hospital from 2020-2021 were recruited. Data on age, sex, height, weight, body mass index, operation duration, blood loss, albumin level, the geriatric nutritional risk index (GNRI), potassium level, the estimated glomerular filtration rate (eGFR), sodium level, length of hospital stay, history of hypertension, dialysis status, the occurrence of delirium during hospital stay, and oral medication use were collected. Comparisons between the postoperative hyponatremia group and the postoperative normonatremia group were conducted to evaluate the impact of hyponatremia on clinical outcomes. Postoperative hyponatremia was observed in 56 (28%) of the 200 patients after spinal surgery. Comparison between the postoperative hyponatremia group with the postoperative normonatremia group revealed that the patients in the postoperative hyponatremia group were significantly older (72 versus 68.5 years, p<0.01). Postoperative hyponatremia was significantly associated with low GNRI values (100.8 versus 109.3, p<0.01), low eGFR values (59.2 versus 70.8 mL/min/1.73 m2, p<0.01), preoperative hyponatremia (138.5 vs. 141 mEq/L, p<0.01), and a high incidence of delirium (12.5% versus 2.7%, p=0.01). Older age (odds ratio=1.04, p=0.01) and preoperative hyponatremia (odds ratio=0.66, p value<0.01) were risk factors for postoperative hyponatremia. In addition to older age and preoperative hyponatremia, the study identified new risk factors for postoperative hyponatremia, which are preoperative undernutrition and impaired renal function. The incidence of delirium was significantly higher in the postoperative hyponatremia group, suggesting that correcting preoperative hyponatremia and ensuring good nutrition may prevent delirium and thereby shorten hospital stays.

Genetic, sociodemographic, lifestyle, and clinical risk factors of heart failure aggravation events: data from the UK Biobank

Abstract Background Heart failure (HF) is the leading cause of readmission and hospitalization. Purpose This study examined the associations and clinical utilities of genetic, sociodemographic, lifestyle, laboratory, and clinical risk factors on HF aggravation. Methods Data were from 5,345 UK Biobank middle-aged adults with established HF at enrolment. We performed Cox proportional hazard regression analyses to investigate the associations related to HF admission after enrolment utilizing 24 variables encompassing sociodemographic, clinical, lifestyle, and laboratory data. To assess the impact of genetic factors, we additionally adjusted each polygenic risk score (PRS) for the three medical histories: hypertension, atrial fibrillation (AF), and coronary heart disease (CHD), where the hazard ratios were statistically significant. Results Over a median follow-up of 11.5 [10.9-12.2] years, 247 (4.6%) HF admission events occurred. Among the 24 variables, statistically significant hazard ratios were observed for 10 variables, with hypertension (3.31, 2.19-5.02), AF (2.06, 1.53-2.75), current smoking (1.63, 1.09-2.46), and coronary heart disease (1.58, 1.17-2.13) showing the highest hazard ratios, while female gender (0.65, 0.46-0.91) exhibited the smallest hazard ratio. After adjusting for each PRS individually, HTN PRS (HR 1.06, 0.94-1.21) and AF PRS (HR 1.02, 0.90-1.16) were not statistically significant, whereas CHD PRS (HR 1.15, 1.02-1.31) showed significance in relation to HF admission. In the HF admission prediction model, the C index was 0.859 (0.838-0.880) with clinical variables, and it marginally increased to 0.864 (0.843-0.885) when all factors, including the genetic factor, were applied. Conclusions Sociodemographic, clinical, laboratory, lifestyle, and genetic factors are each associated with HF aggravation with male gender, hypertension, AF, low eGFR, cigarette smoking, and CHD PRS.

Cardiac implantable electronic devices following orthotopic heart transplantation: insights on indications and outcomes from a single centre experience

Abstract Background Need for cardiac implantable electronic devices (CIED) after orthotopic heart transplantation (OHT) ranges from 7 to 24% of cases depending on several patient and procedural related factors. Purpose The aims of this study were to investigate the frequency, indications and the predictors of CIED implantation (especially permanent pacemaker [PPM]) following biatrial anastomosis OHT. Methods A retrospective, single centre, observational study was conducted, including all the patients who underwent OHT between May 1990 and October 2023 at our Institution. For each patient clinical and procedural information were collected and a long-term active follow-up was performed. The primary endpoint of the study was PPM or implantable cardioverter defibrillator (ICD) implantation while all-cause mortality or de novo OHT was a secondary endpoint. Uni- and multivariable logistic regression analyses were performed to identify factors associated with PPM implantation. Results Overall, 546 patients were included and followed-up for a median of 8 years [IQR 1.2-14.3]. During this time frame, 89 (16.3%) patients required PPM implantation (only one patient [0.2%] underwent ICD implantation) at median time of 110 days [IQR 25-2230] after OHT. The main indication for PPM implantation was the development of sinus node dysfunction in 60 patients (67.4%) whereas 29 (32.6%) patients with atrioventricular block required PPM implantation. During follow-up, 265 deaths (48.5%) occurred but no significant differences in long-term prognosis were observed between patients requiring CIED implantation and those who did not (45.5% vs. 49.1%, p-value=0.53, figure). At multivariable analysis, impaired renal function (i.e. low eGFR), cardiac allograft vasculopathy, the occurrence of severe heart transplant rejection and a higher BMI were factors associated with PPM implantation (table). Conclusions Among patients undergoing OHT with biatrial anastomosis technique, PPM implantation is not uncommon but it does not negatively impact on prognosis. Several factors, especially severe heart transplant rejection, cardiac allograft vasculopathy and impaired renal function can help identifying patients at higher risk of PPM.TableFigure

Factors influencing inappropriate device therapy in implantable cardioverter defibrillators: a predictive analysis

Abstract Background Implantable cardioverter defibrillator (ICD) implantation and subsequent ICD therapy have shown to be efficacious in the prevention of sudden cardiac death. However, patients with an ICD are at risk of inappropriate device therapy (IDT), which is associated with worse outcomes, reduced quality of life (QoL), and may influence psychosocial and mental wellbeing. Purpose This study aimed to predict which patients are at risk of IDT by investigating the influence of pre-implant clinical parameters on occurrence of IDT. Methods From January 2010 to December 2019, patients who received an ICD in our medical center, were included in a prospective registry. Only patients with ICD (including ICDs used for cardiac resynchronization therapy, i.e. CRT-D) with an atrial lead were included in the current analysis, to better distinguish between appropriate and inappropriate device therapy. After implant, the device was interrogated at least every 6 months and clinical symptoms related to the device, recorded events, and relevant technical setting changes were recorded. IDT was defined as antitachycardia pacing (ATP) or shock delivered for any reason other than ventricular arrhythmia. Follow-up ended after IDT, death, or loss-to-follow-up. Results 428 patients underwent an implantation of a dual chamber ICD or CRT-D of various manufacturers. 14 patients were lost to follow-up within the first year and one patient was excluded because of a dislocated atrial lead, leaving 413 patients (76% male, mean age 67±9.7 years, 39% CRT-D) with a minimum of 1-year follow-up. During a mean of 5.3 (±3.0) years, 136 (32.9%) patients received appropriate therapy and 36 (8.7%) patients received IDT. Of those 36 patients, 18 patients received only ATP, 12 received ATP followed by a shock, and 6 patients received a shock without prior ATP. The median time from implantation to IDT was 2.8 [0.3-5.8] years. Univariate logistic regression on 40 clinical parameters followed by a forward multivariate logistic regression was performed. The area under the ROC curve of the resulting multivariate model was 0.724 (95%CI 0.622-0.826). Cox regression analysis resulted in device type (CRT-D) (HR=0.533, 95%CI 0.234-1.211, p=0.133), use of mineralocorticoid receptor-antagonists (MRA) (HR=0.280, 95%CI 0.104-0.754, p=0.012), use of diuretics (HR=3.378, 95%CI 1.479-7.714, p=0.004), and eGFR (HR=1.217, 95%CI 0.972-1.523, p=0.087) as predictors of IDT. A history of atrial fibrillation was not a significant predictor of IDT. Conclusion This study identified CRT-D and use of MRAs to be protective against IDT, and use of diuretics and lower eGFR as risk factors of IDT. To inform patients optimally, pre-implant assessment of those factors could help identify patients at higher risk of IDT. Furthermore, it could dictate more cautious device programming and consequently reduce rates of IDT, reducing the negative influence of IDT on QoL and wellbeing in the ICD population.

#1039 Characteristics and outcome of IgA nephropathy in Switzerland – a single center perspective

Abstract Background and Aims IgA nephropathy (IgAN) is the most common primary glomerulonephritis worldwide leading to end-stage kidney disease (ESKD) in roughly 40% of affected patients by ten years. Geographic differences in clinical course and response to treatment may partly result from different disease entities. The purpose of this retrospective cohort analysis was to study all cases of IgAN from a single tertiary center with respect to clinical and histological characteristics, treatment practices and outcome. Method This retrospective cohort analysis identified 158 cases of adult biopsy-proven IgAN by chart review diagnosed between 1980 and 2017. Detailed phenotypisation including clinical, paraclinical, histological, treatment and outcome parameters was performed. Remission status was defined as described previously (Reich 2007). Statistical analysis was performed using Excel and SPSS software and included standard descriptive methods and included standard descriptive methods and student's t-test on a significance level of 0.05. Results Subjects were majorly male and of Caucasian descent. Mean estimated glomerular filtration rate (eGFR) according to Chronic Kidney Disease Epidemiology Collaboration formula at diagnosis was 55.3 ml/min/1.73 m2, mean proteinuria was 3.2 g/d. 70.3% of patients were hypertensive at presentation. Clinical presentation varied according to age. Thus, younger patients (18-39 years) presented more frequently with macrohematuria, asymptomatic urine abnormalities and by trend acute kidney injury whereas nephrotic syndrome and extrarenal symptoms were recorded in similar proportions of patients (Fig. 1). 28.5% of initial biopsies showed moderate to severe tubular atrophy and interstitial fibrosis (IFTA), 38% included crescents, 1.9% &amp;gt; 50% crescents. 86.1% of the patients were treated by renin-angiotensin-aldosterone-system inhibitors, 46.8% received immunosuppressive therapy including steroids in 46.2% and other immunosuppressive medications in 19.6% the most common being azathioprine (Fig. 2). There were 33.5% complete and 13.3% partial remissions. Progression to ESKD was noted in 42.1%. 51.4% of patients treated with immunosuppressive therapy experienced remission. Recurrence rate after transplantation was 18.4%. Patients treated by immunosuppressants had higher levels of baseline proteinuria (3.2 ± 2.3 vs. 1.6 ± 1.6 g/d, p &amp;lt; 0.00001), lower baseline eGFR (50 ± 31 vs. 61 ± 30 ml/min/1.73 m2, p = 0.04), higher number of crescents (9.4 ± 15.0 vs 2.3 ± 8.5%, p = 0.001), higher IFTA scores (1.7 ± 0.8 vs. 1.3 ± 0.6, p = 0.007) and higher fluorescence intensity scores for C3 (2.0 ± 0.9 vs. 1.6 ± 0.9, p = 0.02) on initial biopsy as compared to patients treated conservatively. Patients progressing to ESKD presented with higher blood pressure (146 ± 26 vs. 135 ± 18 mmHg systolic, p = 0.005; 89 ± 14 vs. 82 ± 14 mmHg diastolic, p = 0.006), lower eGFR (41 ± 29 vs. 64 ± 28 ml/min/1.73 m2, p = 0.00001), higher levels of proteinuria (3.4 ± 2.0 vs. 1.8 ± 1.9 g/d, p = 0.0001), higher number of crescents (9 ± 17 vs. 4 ± 9%, p = 0.03) and higher IFTA scores (1.8 ± 0.8 vs. 1.3 ± 0.6, p = 0.00001) as compared to patients without ESKD at last follow up. Baseline blood pressure (134 ± 18 vs. 147 ± 26 mmHg systolic, p = 0.004; 82 ± 14 vs. 89 ± 15 mmHg diastolic, p = 0.01), eGFR (60 ± 29 vs. 41 ± 27 mmHg, p = 0.0007), proteinuria (2.3 ± 1.9 vs. 3.2 ± 2.3 g/d, p = 0.03) and severity of IFTA (1.4 ± 0.6 vs. 1.8 ± 0.9, p = 0.003) differed significantly between patients who experienced any remission vs. those who did not achieve remission respectively. Conclusion This analysis gives insight into the characteristics and treatment practices of a Swiss single center cohort of IgAN patients from 1980-2017.

#1638 Long-term mortality trends in IgA nephropathy: a study of an Eastern European cohort

Abstract Background and Aims IgA Nephropathy (IgAN), recognized as the most prevalent form of primary glomerulonephritis, has been thoroughly researched in terms of renal outcomes. However, there is a scarcity of data regarding patient survival, especially in Eastern Europe. Our study focuses on exploring the long-term survival rates of IgAN patients and identifying associated risk factors within an Eastern European population. Method In our retrospective study, we analyzed 215 patients with biopsy proven IgAN (median age 44 years, 71% male, median eGFR 40.9 mL/min/1.73 m2, median proteinuria 1.24g/g) diagnosed at a tertiary center in Romania from 2010 to 2017. Our study primarily focused on all-cause mortality and secondarily on the development of ESKD (start of kidney replacement therapy or renal transplantation). The follow-up for patients continued until they reached either of these endpoints or until January 1, 2022, whichever came first. Results During a median follow-up of 7.3 years, 20% of the patients died. The main causes of death were cardiovascular diseases (60%), followed by infectious (19%), gastroenterological (12%), and neoplasia (9%) diseases. Mean survival of the entire cohort was 117.5 months (95% CI: 111.2, 123.8) and mean kidney survival was 98.4 months (95% CI: 90.5, 106.2). Survival rates at 1 year, 5 years and 10 years were 93%, 84% and 77% respectively, and kidney survival rates at 1 year, 5 years and 10 years were 87%, 72% and 58% respectively. When compared to the survivors, deceased patients were significantly older (60 vs 42 years, p 0.001) and had an increased prevalence of diabetes mellitus (26 vs 4%, p 0.001) and higher Charlson comorbidity index (5 vs 2, p 0.001). Deceased patients also had significantly higher serum creatinine levels (3.3 vs 1.6 mg/dL, p 0.001), lower eGFR (18 vs 46 mL/min, p 0.001), and more haematuria (230 vs 183cells/HPF, p 0.01). There was no significant difference in proteinuria between the two groups (1.1 vs 1.2g/g, p 0.3). In the univariate Cox regression analysis, all-cause mortality was significantly associated with several factors: advancing age (HR 1.08, 95% CI: 1.05, 1.11), an increased Charlson comorbidity index (HR 1.60, 95% CI: 1.42, 1.80), the presence of diabetes mellitus (HR 5.13, 95% CI: 2.57, 10.25), lower eGFR (HR 0.95, 95% CI: 0.93, 0.97), increased proteinuria (HR 1.12, 95% CI: 1.00, 1.25), the presence of haematuria (HR 1.26, 95% CI: 1.03, 1.53), lower serum albumin (HR 0.35, 95% CI: 0.22, 0.56), higher MEST-C score (HR 1.38, 95% CI 1.13, 1.69) and absence of renin-angiotensin-system inhibitors (RASI) (HR 0.32, 95% CI 0.17, 0.60). However, in the multivariate analysis, only an increased Charlson comorbidity index (HR 1.31, 95% CI: 1.09, 1.57), lower eGFR (HR 0.98, 95% CI: 0.96-1.00) and absence of RASI (HR 0.21, 95% CI: 0.15, 0.28) retained their statistical significance. Conclusion We report a 20% mortality rate in our Eastern European IgAN cohort, primarily due to cardio-vascular diseases. Death correlates with increased age, comorbidity burden, decreased renal function at diagnosis, and absence of RASI use. RASI treatment may potentially improve survival, highlighting its importance in managing IgAN.

#887 Complement biomarkers in IgA nephropathy and IgA vasculitis with renal involvement: can urine rather than blood be the answer?

Abstract Background and Aims IgA nephropathy (IgAN) is the most common glomerulonephritis worldwide. Dysregulation of the complement system is considered a part of the pathogenesis and can occur both in the circulation and locally in the kidney. Despite this, most studies have focused on complement biomarkers in the blood, rather than in urine. Our aim was to evaluate a wide range of complement-related proteins in blood and urine at diagnosis and their association with disease activity in biopsy findings, proteinuria, and outcome. We added PTX-3, a protein expressed in activated endothelial cells, which can be both produced by and activate mesangial cells in IgAN and has a function in all three complement pathways. Adult-onset IgA vasculitis with renal involvement (IgAVN) shares many similarities with IgAN and cannot currently be distinguished by kidney biopsy or any established biomarker. We therefore also aimed to compare the same biomarkers between these two disorders. Method In a Swedish cohort of 96 patients with IgAN (n = 65) and IgAVN (n = 31), who had been followed prospectively for a median of 10.8 years, we performed the following analysis in plasma and urine in samples stored at the time of kidney biopsy. Analyses in plasma (p-) included C3bc, C4c, C5b-9, MASP2, MASP3, MAP1, FCN 1-3, MBL, CL11 and PTX-3 and in urine (u-) C3bc, C4c, C5b-9, MASP3, FCN2, FCN3, MBL and PTX-3. An in-house developed sandwich ELISA was used for all analyses. Kidney biopsies were classified according to the Oxford MEST-C score, describing (simplified for this small cohort) the presence vs absence (1 vs 0) of mesangial proliferation (M), endocapillary proliferation (E), segmental sclerosis (S), tubular atrophy/interstitial fibrosis (T) and crescents (C). Severe outcome was defined by a combination of an eGFR slope &amp;gt; 2.5 ml/min/1.73 m2 per year or end stage kidney disease. For statistical analysis, Mann-Whitney U test was performed for comparison between independent groups, Chi squared test and Fisher's test for categorical variables and Spearman's ranks test for correlation analysis. Median values are presented without IQR for this abstract. Results Urine samples were available in 59 patients (IgAN n = 39, IgAVN n = 20). Patients with detectable u-MBL (28.9%) and u-C5b-9 (27.1%) had higher levels of proteinuria than those with undetectable levels (1.5 g/d vs 0.71g/d; p = 0.009 and 2.3 g/d vs 0.7 g/d respectively; p &amp;lt; 0.001). Lower eGFR (71 ml/min/1.73 m2 vs 88 ml/min/1.73 m2; p = 0.034) were observed if u-C5b-9 was measurable. Detectable levels of u-PTX-3 and u-MBL were more often found in the presence of M1 vs M0 (53% vs 20%; p = 0.022 and 47% vs 12.5%; p = 0.011), E1 vs E0 (55% vs 14%; p = 0.001 and 40% vs 11%; p = 0.020) and C1 vs C0 (56% vs 11%; p = 0.003 and 44% vs 11%; p = 0.012). No differences in proteinuria or eGFR were seen in patients with or without detectable u-PTX-3. The degree of proteinuria was positively correlated to the levels of u-C3bc (r = 0.33; p = 0.011) and u-C4c (r = 0.39; p &amp;lt; 0.001). U-C4c levels were higher in patients with M1 vs M0 (54.4 Au/mL vs 23.8 Au/mL; p = 0.037) and T1 vs T0 (53.2 Au/mL vs 23.8 Au/mL; p = 0.034). Concerning the analyses in plasma (n = 95), lower p-MASP3 and p-CL11 levels were correlated with lower eGFR (r = 0.29; p = 0.004 and r = 0.31, p = 0.002). Moreover, lower p-MASP3 levels were detected in patients with E1 vs E0 (2918 ng/mL vs 3404 ng/mL; p = 0.002) and C1 vs C0 (3053 ng/mL vs 3427 ng/mL; p = 0.015). Both p-C5b-9 (13.3 Au/mL vs 8.2 Au/mL; p = 0.001) and p-FCN 1 (395 ng/mL vs 289 ng/mL; p = 0.001) were higher in patients with C1 vs C0. No single complement-related protein was associated with severe outcome, and no statistically significant differences in plasma or urine levels between patients with IgAN and IgAVN were observed. Conclusion Increased urinary levels of MBL and PTX-3 could be potential biomarkers of disease activity in both IgAN and IgAVN, whereas excretion of C5b-9 might be more unspecific and associated with chronic damage. However, these results need to be confirmed in larger and more ethnically diverse cohorts. The impact of treatment on these potential biomarkers for disease activity need to be evaluated in longitudinal studies.

#1623 Risk factors for end-stage kidney disease and death in ANCA-associated vasculitis with glomerulonephritis

Abstract Background and Aims ANCA-associated vasculitis (AAV) with glomerulonephritis (AAV-GN) still carries poor prognosis despite treatment improvement over the last years. Currently, improving assessment of disease activity and severity and defining risk factors for ESKD pose challenges. In this study we aim to determine and characterize risk factors associated with progression to ESKD or death in patients with AAV-GN. Method We retrospectively analysed all AAV-GN cases of our Center. ESKD was considered as a composite outcome of eGFR&amp;lt;15 or dialysis dependency. Biopsies were classified according to Berden's classification (BC), Brix's renal risk score (RRS), Mayo Clinic Chronicity Score (MCCS) and AAV-GN combined score (AAV-GN-CS). Categorical variables were analysed by non-parametric chi-square or fisher's exact test; and continuous variables by Mann-Whitney U test. Cox regression models were applied for death and Kaplan-Meier estimator. Significance value α = 0.05 was considered. Results A total of 74 patients, 56.8% male, 69 years-old median age were included. Of them, 81.2% were MPO, 11.6% PR3 and 7.2% negative. At presentation, 35.3% had alveolar haemorrhage, 13.4% GI and 66.7% constitutional manifestations. At diagnosis, median eGFR was 7.5 mL/min/1.73 m2 (5.0-13.0), proteinuria 2.2g/g (0.45-4.17) and all patients had haematuria. Initial median ANCA titer (ATi) was 100 UI/mL (51-134) and at last follow-up 44 (15-101). 64.2% of all patients required dialysis at presentation. Of these, 14.0% recovered until discharge. We also analyzed biopsies of 57 patients. According to BC, 15.8% were focal, 40.4% crescentic, 26.3% mixed, and 17.5% focal. ESKD risk was medium in 28.3% and high in 69.8%, as determined by RRS; whereas low in 31%, intermediate in 42.3% and high in 19% as per AAV-GN-CS. Induction treatment (IT) used was cyclophosphamide (CYC) in 46.3%, CYC plus rituximab (RTX) in 18.3% and RTX in 3.3%. Only 17 patients (26.2%) were added plasmapheresis (PLEX). Only 28% achieved kidney remission (KRm), 7% relapsed and 68.7% developed ESKD. Of them, 95.5% had eGFR&amp;lt;15 at diagnosis, 30% low C3, 37.5% crescentic pattern, 28.1% mixed and 28.1% sclerotic. 87% of ESKD patients had &amp;lt;25% normal glomeruli (NG), and 87.1% high ESKD risk (RRS). Progression to ESKD was associated with lower eGFR (p &amp;lt; 0.001) and low C3 at diagnosis (p = 0.026), lower %NG (p = 0.004), higher %CG (p = 0.004), higher %IFTA (p = 0.011), worse BC (p = 0.012), higher RRS (p &amp;lt; 0.001) and MCCS categories (p = 0.010), but not with AAV-GN-CS. ATi reduction seems to determine better renal outcome (p = 0.042). No significant differences were seen with IT or maintenance treatment, nor with PLEX addition. No patient treated with RTX, or combined treatment developed ESKD. Mortality was 32.8% and the best predictive model includes age, GI manifestations and KRm (p &amp;lt; 0.001). Age (p = 0.004), lower eGFR at diagnosis (p = 0.016) and GI manifestations (p = 0.003) were predictive of death, while achieving KRm improved survival (p = 0.009). Conclusion Our results reveal that AAV-GN patients have poor kidney outcome when presenting with severe kidney dysfunction, high ANCA titers and low C3 levels. Worse histological scoring is determinant of ESKD. The prediction power of AAV-GN-CS must be demonstrated in large cohorts. RTX effectivity on kidney survival must be further supported. Patient survival is related with younger age at diagnosis, organ systems involved at clinical presentation, and achievement of kidney remission.

#896 Long-term renal outcome in childhood-onset lupus nephritis

Abstract Background and Aims Lupus nephritis (LN) is a common and severe complication of childhood-onset SLE. Little is known about the long-term renal outcome of childhood-onset LN. We investigated predictive factors of end-stage kidney disease (ESKD) and chronic kidney disease (CKD) in a paediatric cohort of patients with LN. Method This is a retrospective multicentre study including patients with childhood-onset (&amp;lt;18 years) biopsy-proven LN. Clinical features were analysed at disease onset, time of kidney biopsy, 12 and 24 months after biopsy, and last follow-up. We investigated the prognostic significance of clinical, laboratory and histologic characteristics on the incidence of ESKD and CKD stage 3-5. Results We included 73 patients with a median age of 14 years (IQR 11.5-17) . At the time of kidney biopsy, most subjects displayed an aggressive disease: 2 (3%) children required haemodialysis, 27 (38%) had an estimated glomerular filtration rate (eGFR) &amp;lt;60 mL/min/1.73 m2. The overall median eGFR was 70 mL/min/1.73 m2 (IQR 43-96) . Moreover, the median proteinuria was 4 g/24 h (IQR 1.35-7.41) , with 41 (59%) children displaying a nephrotic range proteinuria (i.e., &amp;gt;3 g/24 h) . The median follow-up was 13.3 years (IQR 4.7-25.4) . A total of 10 patients (13.7%) reached ESKD, the majority of whom (12%) within 10 years from kidney biopsy; during the subsequent follow-up the incidence of ESKD stabilised (Fig. 1). At last follow-up, around 50% of patients displayed an eGFR &amp;lt;90 mL/min/1.73 m2. A younger age at LN onset, a lower eGFR and central nervous system involvement at the time of kidney biopsy were identified as predictors of ESKD by a univariable Cox regression model (Table 1). The same features were significantly associated with the occurrence of CKD stage 3-5 at last follow-up at a univariable logistic regression analysis. Conclusion LN often presents with severe kidney function impairment and aggressive systemic involvement in children. In our cohort, whose follow-up was among the longest reported in the literature, 12% of patients reached ESKD within 10 years from kidney biopsy. Significant predictors of poor kidney outcome in the long term were a younger age at LN onset, a lower eGFR and the presence of neurological manifestations at the time of kidney biopsy.

#3094 Prevalence and risk factors for progression and mortality in patients with advanced chronic kidney disease

Abstract Background and Aims Chronic kidney disease (CKD) is a growing health concern worldwide. Prevalence and risk factors for its progression are highly relevant, given that Portugal has the highest incidence and prevalence rates of dialysis in Europe. With this study, we aimed to estimate the prevalence of patients with CKD stage 4 and 5 in a tertiary center in Portugal, as well as to evaluate risk factors for progression and mortality. Method We evaluated all patients followed in the Nephrology outpatient clinic at a tertiary center in Portugal during the year 2021, and selected those with CKD stage 4 and stage 5, based on estimated glomerular filtration rate (eGFR) using CKD-EPI formula. Primary endpoints were CKD progression or mortality after 1 year of follow-up. Progression was defined as initiating renal replacement therapy (RRT) or transition from stage 4 to stage 5 CKD. Results We evaluated 4381 patients, of which 1083 (24.7%) were included with CKD stage 4 (n = 856) and CKD stage 5 (n = 227). There was a predominance of males (52.7%), with a mean age of 74.6 ± 12.5 years. We observed a high prevalence of hypertension (94%), diabetes mellitus (46.2%), dyslipidemia (81%), heart failure (34%) and past history of major cardiovascular events (21%). At one year follow-up 108 patients died, 116 lost follow-up, and 256 (26.5%) had CKD progression, of which 179 (18.5%) initiated renal replacement therapy. 33.5% of patients initiating dialysis had a definitive access, mostly in stage 5 CKD (40 vs. 25%, p &amp;lt; 0.05). Risk factors for progression (versus stability) in univariate analysis were male gender (64.5 vs. 50.1, p &amp;lt; 0.001), younger age (68 vs. 75 years, p &amp;lt; 0.001) and lower eGFR (16 vs. 22 mL/min). Progression occurred in 51% of stage 5 CKD vs. 26.5% stage 4. Worse laboratory control of anemia, hyperparathyroidism, acidosis, and albuminuria (urinary albumin/creatinine ratio 1242 vs. 302 mg/g, p &amp;lt; 0.01) were identified risk factors for progression. In multivariate analysis, predictors for CKD progression were younger age (OR: 0.97, CI: 0.95-0.99, p = 0.02), male gender (OR: 2.82, CI: 1.43-5.57, p = 0.003), lower eGFR (OR: 0.80, CI: 0.74-0.86, p &amp;lt; 0.001), lower hemoglobin levels (OR: 0.62, CI: 0.48-0.79, p &amp;lt; 0.001), and proteinuria (OR: 1.44, CI: 1.22-1.53, p 0.003). Regarding mortality, no statically significant differences were observed between CKD stage 4 and 5, and in multivariate analysis the only independent risk factors for death were older age and heart failure, which increased 3.4 times mortality risk (OR: 3.40, CI: 1.48-7.83, p = 0.04). Conclusion Our data show a high prevalence of CKD and traditional risk factors, with an annual progression rate of 26.5%. Anemia and proteinuria were identified as modifiable risk factors for progression. In older patients with heart failure, the mortality risk was found to be higher than progression risk, highlighting the importance of cardiovascular protection and consideration of conservative management in this particular subset of patients.

Dietary inflammatory index and lower glomerular filtration rate in Mexican adults

We hypothesized that higher scores on the dietary inflammatory index (DII) would be associated with a lower glomerular filtration rate (GFR). This cross-sectional study included 2098 participants from Mexican Teachers Cohort Study, the Health Workers Cohort Study, and the Comitán Study belonging to the RenMex consortium. Energy-adjusted DII scores were estimated using a semi-quantitative food frequency questionnaire (FFQ). eGFR was estimated by the CKD Epidemiology Collaboration equation. Quantile regression models and ordered regression models were estimated to assess the associations of interest. Median age of study participants was 47 years, median eGFR was 102.9 mL/min/1.73m2, and the median energy-adjusted DII was 0.89 (range, -2.25, +4.86). The median eGFR was lower in participants in the highest percentile of DII compared to those in the lowest percentile (103.8 vs 101.4). We found that continuous and categorical energy-adjusted DII scores were associated with lower eGFR, especially at the lower percentiles. In adjusted ordered logistic regression, we found that the highest DII category was associated with 1.80 times the odds of belonging to the mildly decreased eGFR category or moderately decreased eGFR category compared lowest DII category (OR: 1.80, 95%CI 1.35, 2.40). A high DII score was associated with a lower eGFR among the Mexican population. Additional studies are crucial to validate these findings and explore potential strategies to reduce the consumption of pro-inflammatory foods as a preventive approach for chronic kidney disease (CKD).

#2071 The metabolic syndrome impact in the onco-nephrological scenario of renal cancer: when comorbidities beat surgery

Abstract Background and Aims Metabolic syndrome (MS) represents a pathological state in which many risk factors for CKD including obesity, hyperglycemia, hypertension and dyslipidemia co-occur within individuals. In the past decade different lines of evidence underlined the relationship between MS and CKD, two increasing worldwide serious threat to life. With the rise of onco-nephrology, there is a strong need to define the role of MS in the nephrological management of oncological patients. Our study aimed to assess the impact of metabolic syndrome on renal function in patients undergoing partial nephrectomy (PN) for renal cancer (RC). Method We retrospectively analyzed data from 1,112 patients undergoing PN at a tertiary referral center between 2000 and 2023. Patients with metastatic disease, hereditary cancer or a solitary kidney were excluded. Renal function was evaluated with eGFR values using CKD-EPI 2021 formula. AKI and CKD onset were defined using K-DIGO 2012 criteria. MS was defined as at least 3 of the following conditions: obesity, insulin resistance, dyslipidemia and hypertension. Multivariable analyses (MA) were used to determine the impact of MS on preoperative eGFR impairment and post-operative AKI. Covariates were intraoperative blood loss, surgical experience, pT stage, type of surgery (open vs minimally invasive), pre-existing CKD, age, and comorbidities (defined as Charlson Comorbidity Index&amp;gt;3). Results Overall, the rate of MS was 9% (n = 100). The median follow-up was 60 months (IQR 28-68). Patients with MS had lower preoperative eGFR (78 ml/min vs. 87 ml/min), higher estimated blood loss (500 ml vs. 300 ml) and higher rate of complications (38% vs. 29%) relative to non-MS counterparts (all p &amp;lt; 0.001). Additionally, the rate of AKI was 25% (n = 25) vs 18% (n = 182) for metabolic vs non-MS patients (p = 0.01), respectively. At MVA, MS was an independent predictor for both lower preoperative eGFR (OR 1.07, 95% CI 1.01-1.14, p = 0.01) and higher risk of AKI (OR 2.1, 95% CI 1.3-4.1, p = 0.01). MS patients had a worse kidney function at baseline, had higher risk of AKI immediately after surgery and a higher risk of CKD onset over time, with a steep reduction of eGFR even at long term follow-up (Fig. 1). Conclusion Renal cancer patients diagnosed with MS harbored an increased risk of both AKI and CKD even with a partial nephrectomy. Therefore, the role of onco-nephrologists and nutritionists remains a cornerstone in the management of such cohort of patients, before and after surgery.

#2817 Preliminary results of dapagliflozin in inactive lupus nephritis cross-over randomized trial

Abstract Background and Aims Sodium-glucose co-transporter 2 (SGLT2) inhibitors slow the progression of chronic kidney disease (CKD). Lupus nephritis (LN) patients in remission may continue with residual proteinuria due to scars and hyperfiltration. However, LN patients were excluded from the main trials with SGLT2 inhibitors. This trial aims to assess the effect and safety of dapagliflozin in inactive LN patients with residual proteinuria. Method For this cross-over randomized trial, we include adult patients with LN class III, IV (±V) without active nephritis but with proteinuria &amp;gt;500 mg/24 h or UPC &amp;gt; 200 mg/g and eGFR ≥ 20 ml/min, in the maintenance treatment with a RAAS and mycophenolate mofetil (&amp;lt;2g/day) in stable a dose for at least four weeks before the randomization. We excluded patients with other etiologies of CKD, those with active LN lesions on the recent biopsy (AI&amp;gt;2), use of induction therapy in the last 12 months (cyclophosphamide, mycophenolate mofetil &amp;gt;2g/day and calcineurin inhibitors) and prednisone dose ≥ 20 mg/day. Due to safety issues, we excluded patients with recurrent urinary infections (&amp;gt;3 times/year). Those included were randomized to receive dapagliflozin 10 mg on top of standard of care therapy (SoC) or not. After 24 weeks the groups were switched and those without dapagliflozin received it for the next 24 weeks. Primary endpoint is reduction of proteinuria compared to baseline at 6 and 12 months. Secondary endpoints are sustained reduction of eGFR&amp;gt;30%; occurrence of hypotension symptoms; and number of infections on dapagliflozin treatment versus exclusive SoC therapy. The sample size was calculated for 28 patients enrolled providing 80% power to detect a 25% relative risk reduction in proteinuria (α level of 0.05). Results From 97 screened class III, IV (± V) LN patients under maintenance therapy, we excluded 67 due to active nephritis, low proteinuria or low eGFR. We included 30 patients that were randomized 14 to start the treatment with dapagliflozin on top of SoC and 16 to remain with the usual therapy for 24 weeks. Six patients were excluded from the analysis due to new LN flare or lost to follow-up. We analyzed the data of 12 patients in the initial Dapa + SoC and 12 patients in the initial SoC group after 3 (n = 21), 6 (n = 18), 9 (n = 14) and 12 (n = 12) months. Patients in initial Dapa group had a significant decrease in proteinuria after 6 months (1159 to 882 mg/day; p = 0.017) but increased to 1105 mg/day 6 months after the drug withdrawal (Fig. 1A). This preliminary analysis shows a significant reduction in the proteinuria of –35.8% in patients after 6 mo of dapagliflozin as opposed to an increase in 7.2% for those in the SoC therapy at the end of a 6 mo period, p = 0.02 (Fig. 1C). The drug was well tolerated, but 4 (33.3%) of the patients reported hypotension symptoms during the first days of dapagliflozin. There was one case of urinary infection in each group, but in the same patient. Conclusion Preliminary results show a significant reduction in residual proteinuria in patients with inactive LN with dapagliflozin without an increase in infections.

#2756 Metabolomic prediction of end stage renal disease in large national biobanks

Abstract Background and Aims Identifying at-risk individuals likely to progress to end-stage renal disease as early as possible is important to effectively concentrate preventative interventions. Existing predictive tools, like the kidney failure risk score, are effective for individuals who already have moderate to severe kidney disease. Here we examine whether comprehensive metabolomics can improve performance in individuals with mildly impaired kidney function. Method Using an NMR metabolomics platform we measured &amp;gt;200 biomarkers including creatinine, albumin, lipids, fatty acids, amino acids, glycolysis metabolites and inflammation markers in blood samples from all 500,000 participants of the UK Biobank, who have &amp;gt;10 years of linked prospective follow-up data. We used machine learning to develop a score to predict kidney disease progression based on biomarkers, age and sex. We compared its performance to eGFR in a held out set of individuals in UK Biobank, and replicated in 200,000 participants of the Estonian Biobank. Results Among individuals with prevalent diabetes, hypertension or eGFR &amp;lt; 90 the biomarker score performs as well as or better than eGFR for all individuals. In particular it outperforms among individuals with only moderate (eGFR 60-75) or mild (eGFR 75-90) impairment of kidney function with an AUC increase from 0.63 to 0.72 and 0.48 to 0.70, respectively (Figure). This improvement is driven by contributions from numerous biomarkers, including lipids and inflammation markers. Furthermore, because these biomarkers capture diverse metabolic risk, the biomarker score also strongly predicts major adverse cardiovascular outcomes. Conclusion This large dataset allows detailed investigation of the value of metabolomics in identifying future risk of severe kidney disease early. In particular these biomarkers can highlight individuals who do not already have very low eGFR.

#2120 Impact on CKD classification and comorbidities using GFR estimated by European Kidney Function Consortium equation in kidney transplant recipients

Abstract Background and Aims In 2020, European Kidney Function Consortium (EKFC) proposed a new equation that estimates glomerular filtration rate (GFR) in European population. Few studies have compared EKFC with CKDEPI, particularly in kidney transplant (KT) recipients. Chronic Kidney Disease (CKD) classification by KDIGO is used not only by nephrologists who evaluate more parameters of kidney function, but also by every other specialist who are going to be guided mainly by this stage. Our objective is to compare EKFC equation and CKDEPI in classifying CKD in KT patients and its relationship with associated comorbidities. Method We conduct a retrospective observational study including all KT performed at our centre from 1993 to 2022 with survival greater than one year. We collect creatinine, haemoglobin (Hb), phosphorus (P−), potassium (K+), and bicarbonate (Bic) values at three months and one-year post-transplant. We define anaemia as Hb &amp;lt; 11 g/dl, hyperphosphataemia as serum P− &amp;gt; 4.5 mg/dl, hyperkalaemia as serum K+ &amp;gt; 5 mEq/ml, and acidosis as Bic &amp;lt; 22 mEq/L. We calculate estimated GFR (eGFR) using CKDEPI and EKFC equations, classify CKD stage according to KDIGO, and compare both results in terms of correlation and differences. We use Kappa Coefficient and Chi-Square by contingency tables, and ROC curves with homogeneity test for prediction of these comorbidities. We use SPSS and MedCalc as statistics programs. Results We include 968 KT, with median age at the time of transplant 52.75 year [41.25-61.27]. 294 KT (30.4%) are in women. Comorbidity frequencies are depicted in Table 1. ROC analysis shows no significant differences in predicting acidosis at one year, hyperphosphataemia at any time, hyperkalaemia at 3rd month, anaemia at any time, and composite event at any time. We find significant differences in favour to CKDEPI for acidosis at 3rd month (ΔAUC 0.00575 95% CI [0.00182-0.00969]; p = 0.0042) and for hyperkalaemia at one year (ΔAUC = 0.00853 [0.00161-0.0154]; p = 0.0157). Through contingency tables we compare classification into stages, finding very good agreement based on the Kappa coefficient (κ) but significant differences by Chi-Square. With κ = 0.905, EKFC reclassifies 70 patients, 7.23% overall, but not significantly down nor upstaging (31 vs 39). It reclassifies more men than women: 8.46% vs 4.42%. In 10-year age groups, the largest reclassification occurs in the 70-80 years group, a 17.07% with κ = 0.774, all cases upstaged. At one-year eGFR, contingency tables also show a very good agreement based on κ but significant differences by Chi-Square. EKFC reclassifies 83 KT (κ = 0.887), 8.57% overall. It reclassifies 7.48% women and 9.05% men. In 10-year age groups, the largest reclassification occurs in 20-30 years group with 17.24% (κ = 0.767) and 14.81% in 70-80 years (κ = 0.796). All patients in these groups were upstaged. We resume graphically the reclassification of the groups in Fig. 1, observing how EKFC upstages CKD (worsen CKD stage) in high eGFR stages, and downstages CKD in low eGFR stages. Conclusion Estimation of GFR in KT recipients using the new EKFC equation yields similar results to CKDEPI, showing very good agreement for CKD classification although there is a non-negligible percentage of reclassification, which may be clinically relevant in terms of treatment indications and diagnostic tests. It is to a worse CKD stage in high eGFR and to a better stage in low eGFR, and when EKFC reclassification percentage is greater—in the extreme ages of our cohort—it is always by upstaging. Except for minimal differences which we consider clinically inconsequential, we find no significant differences between both equations in discriminating presence of hyperphosphatemia, hyperkalaemia, anaemia or acidosis.

#777 Renal recovery for patients with ANCA-associated vasculitis and low eGFR in a Spanish cohort

Abstract Background and Aims Renal failure secondary to ANCA-associated vasculitis (AAV) represents a clinical and therapeutic challenge [1]. Fifteen percent to 38% of the patients develop end-stage kidney disease within 5 years, and once patients need dialysis, 29% to 82% die or remain on dialysis 3 to 6 months after its initiation [2]. Therefore, effectively managing renal vasculitis and preventing patients from reaching dialysis have important consequences [2]. A post hoc analysis of ADVOCATE trial examined outcomes in a patient subgroup with severe renal insufficiency (i.e., estimated glomerular filtration rate (eGFR) ≤20 ml/min per 1.73 m2) at enrollment into the trial, and observed an average eGFR increase of 16.1 and 7.7 ml/min per 1.73 m2 in the avacopan and prednisone groups, respectively (P = 0,003) [2]. This study aimed to compare the average eGFR increase in our cohort of AAV with severely reduced GFR (&amp;lt;20 ml/min) treated with different induction treatment schemes. Method We performed a retrospective study which included 19 patients with the diagnosis of AAV and severe renal insufficiency at onset with eGFR between 15 to 20 ml/min per 1.73 m2. We analyzed the eGFR increase after 12 months of follow-up, according to the induction treatment scheme: cyclophosphamide, rituximab, a combination of cyclophosphamide and rituximab and other (prednisone alone, prednisone with plasma exchange or prednisone with mycophenolic acid). We compared our results to those obtained in the avacopan and prednisone groups in the ADVOCATE trial. Results In the subgroup of eGFR between 15 to 30 ml/min per 1.73 m2, patients had at enrollment a mean eGFR of 21 ± 5 ml/min per 1.73 m2 and after 12 months of follow-up the mean eGFR was 41 ± 23 ml/min per 1.73 m2 with an increase of 20 ± 23 ml/min per 1.73 m2. In the subgroup of eGFR between 15 to 20 ml/min per 1.73 m2, patients had at enrollment a mean eGFR of 17 ± 2 ml/min per 1.73 m2 and after 12 months of follow-up, the mean eGFR was 35 ± 20 ml/min per 1.73 m2 with an increase of 18 ± 21 ml/min per 1.73 m2. After 12 months of follow-up, the mean increase of eGFR was 18, 17, 10 and 23 ml/min per 1.73 m2 in the cyclophosphamide, rituximab, a combination of cyclophosphamide and rituximab and other groups, respectively. We compared our results with the post hoc analysis of the ADVOCATE trial in Table 1 and our results are similar to the avacopan group and better than the prednisone group (p &amp;lt; 0.05). Conclusion In our cohort of eGFR between 15 to 20 ml/min per 1.73 m2 at enrollment, the mean increase in eGFR after 12 months of follow-up was similar to the avacopan group and greater than the prednisone group in the ADVOCATE trial.