{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T20:01:36Z","timestamp":1792008096056,"version":"4.4.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"vor","delay-in-days":183,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100015303","name":"Otsuka Pharmaceutical Development and Commercialization","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015303","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,30]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Hypothesis<\/jats:title>\n                    <jats:p>We assessed disease progression among patients with immunoglobulin A nephropathy (IgAN) and characterized factors associated with risk for adverse outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective longitudinal cohort (2000\u20132022) study of adults with biopsy-confirmed IgAN within Kaiser Permanente Southern California was performed. The outcome of interest was a composite of \u226550% estimated glomerular filtration rate (eGFR) decline, kidney failure, or mortality. Cox proportional hazards regression modeling was used to estimate hazard ratios (HR) for the eGFR decline\/kidney failure with adjustment for potential confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 655 patients with primary IgAN (31% Asian\/Pacific Islander, 3% Black, 40% Hispanic\/Latino, 24% White), 234 (36%) reached the composite outcome of \u226550% eGFR decline (17%), kidney failure (16%), or mortality (3%). The composite outcome occurred at a rate of 79.4 events (95% confidence intervals (CI) 69.6, 90.7) per 1000 patient-years, with a median time to event of 2.7 years. Compared to urine protein creatinine ratio (UPCR) &amp;lt;0.5 vs 0.5\u2013&amp;lt;1\u00a0g\/g, 1\u20132, and &amp;gt;2\u00a0g\/g, the HR (95% CI) for \u226550% eGFR decline\/kidney failure were 2.4 (1.1, 5.1), 3.2 (1.5, 6.6), and 5.1 (2.5, 10.4) for baseline UPCR and 5.4 (2.3, 13.0), 14.4 (16.5, 32.2), and 41.2 (17.9, 94.5) for time-averaged UPCR. Lower baseline eGFR and diabetes were also associated with higher risk, while age \u226530 years was associated with lower risk for \u226550% eGFR decline\/kidney failure. There were no clear trends differentiating risk by race\/ethnicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this large, diverse cohort, high rates of kidney outcomes occurred within a relatively short follow-up duration. Our findings suggest that IgAN carries elevated risk for kidney outcomes starting at proteinuria levels \u22650.5\u00a0g\/g, in contrast to earlier perceptions that levels below 1\u00a0g\/g are associated with low risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ndt\/gfaf084","type":"journal-article","created":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T19:29:53Z","timestamp":1746041393000},"page":"2104-2117","source":"Crossref","is-referenced-by-count":41,"title":["CKD progression, kidney failure, and mortality among US patients with IgA nephropathy"],"prefix":"10.1093","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9456-8243","authenticated-orcid":false,"given":"John J","family":"Sim","sequence":"first","affiliation":[{"name":"Kaiser Permanente Los Angeles Medical Center Department of Nephrology and Hypertension, , Los Angeles, CA ,","place":["USA"]},{"name":"Kaiser Permanente Southern California Department of Research & Evaluation, , Pasadena, CA ,","place":["USA"]},{"name":"Kaiser Permanente Bernard J. Tyson School of Medicine Department of Clinical Science, , Pasadena, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiaoling","family":"Chen","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Southern California Department of Research & Evaluation, , Pasadena, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Cannizzaro","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Southern California Department of Research & Evaluation, , Pasadena, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ancilla W","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Otsuka Pharmaceutical Development and Commercialization, Inc. , Princeton, NJ ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cibele","family":"Pinto","sequence":"additional","affiliation":[{"name":"Otsuka Pharmaceutical Development and Commercialization, Inc. , Princeton, NJ ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simran K","family":"Bhandari","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Bernard J. Tyson School of Medicine Department of Clinical Science, , Pasadena, CA ,","place":["USA"]},{"name":"Kaiser Permanente Downey Medical Center Department of Internal Medicine, , Downey, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Chang","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Southern California Department of Research & Evaluation, , Pasadena, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asher D","family":"Schachter","sequence":"additional","affiliation":[{"name":"Visterra, Inc. , Waltham, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohit","family":"Mathur","sequence":"additional","affiliation":[{"name":"Visterra, Inc. , Waltham, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,4,30]]},"reference":[{"key":"2025102920021637500_bib1","doi-asserted-by":"publisher","first-page":"16001","DOI":"10.1038\/nrdp.2016.1","article-title":"IgA nephropathy","volume":"2","author":"Lai","year":"2016","journal-title":"Nat Rev Dis Primers"},{"key":"2025102920021637500_bib2","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1093\/ndt\/gfq665","article-title":"The incidence of primary glomerulonephritis worldwide: a systematic review of the literature","volume":"26","author":"McGrogan","year":"2011","journal-title":"Nephrol Dial Transplant"},{"key":"2025102920021637500_bib3","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.34067\/KID.0000000000000165","article-title":"Global Incidence of IgA nephropathy by race and ethnicity: a systematic review","volume":"4","author":"Kiryluk","year":"2023","journal-title":"Kidney360"},{"key":"2025102920021637500_bib4","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1159\/000541869","article-title":"Incidence of adult primary immunoglobulin A nephropathy among a racially\/ethnically diverse population in the United States","volume":"56","author":"Sim","year":"2024","journal-title":"Am J Nephrol"},{"key":"2025102920021637500_bib5","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1007\/s00467-016-3469-3","article-title":"Risk factors for progression in children and young adults with IgA nephropathy: an analysis of 261 cases from the VALIGA European cohort","volume":"32","author":"Coppo","year":"2017","journal-title":"Pediatr Nephrol"},{"key":"2025102920021637500_bib6","doi-asserted-by":"publisher","first-page":"36","DOI":"10.36469\/jheor.2021.26129","article-title":"A systematic literature review of the epidemiology, health-related quality of life impact, and economic burden of immunoglobulin A nephropathy","volume":"8","author":"Kwon","year":"2021","journal-title":"J Health Econ Outcomes Res"},{"key":"2025102920021637500_bib7","doi-asserted-by":"publisher","first-page":"303","DOI":"10.3390\/diagnostics13020303","article-title":"IgA nephropathy: current understanding and perspectives on pathogenesis and targeted treatment","volume":"13","author":"Du","year":"2023","journal-title":"Diagnostics"},{"key":"2025102920021637500_bib8","doi-asserted-by":"publisher","first-page":"427","DOI":"10.34067\/KID.0000000000000379","article-title":"Kidney failure events, cardiovascular disease events, and all-cause mortality in patients with IgA nephropathy in a real-world database","volume":"5","author":"Lerma","year":"2024","journal-title":"Kidney360"},{"key":"2025102920021637500_bib9","doi-asserted-by":"publisher","first-page":"3177","DOI":"10.1681\/ASN.2007050526","article-title":"Remission of proteinuria improves prognosis in IgA nephropathy","volume":"18","author":"Reich","year":"2007","journal-title":"J Am Soc Nephrol"},{"key":"2025102920021637500_bib10","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.kint.2021.05.021","article-title":"Kidney Disease: Improving Global Outcomes Glomerular Diseases Work Group. 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