{"doi":"10.1093/ndt/gfae085","title":"Albuminuria predicts kidney events in IgA nephropathy","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 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.","journal":"Nephrology Dialysis Transplantation","year":2024,"id":419238,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":42,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.957,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1208636,"name":"Sigrid Lundberg","orcid":"0000-0003-1224-5200","position":1,"is_corresponding":false},{"id":1209213,"name":"Stefania Lando","orcid":null,"position":2,"is_corresponding":false},{"id":867393,"name":"Julia Wijkström","orcid":"0000-0001-6183-5878","position":3,"is_corresponding":false},{"id":694040,"name":"Mårten Segelmark","orcid":"0000-0002-1221-0772","position":4,"is_corresponding":false},{"id":857940,"name":"Marie Evans","orcid":"0000-0001-8650-5795","position":5,"is_corresponding":false},{"id":19388,"name":"Juan Jesús Carrero","orcid":"0000-0003-4763-2024","position":6,"is_corresponding":false},{"id":1074678,"name":"Anne‐Laure Faucon","orcid":"0000-0001-6716-1157","position":0,"is_corresponding":true}],"reference_count":35,"raw_metadata":null,"created_at":"2026-07-19T01:57:14.586331Z","pmid":"38688876","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}