{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:46:16Z","timestamp":1791906376886,"version":"4.3.4"},"reference-count":36,"publisher":"S. Karger AG","issue":"4","license":[{"start":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T00:00:00Z","timestamp":1754438400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"},{"start":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T00:00:00Z","timestamp":1754438400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Nephrol"],"abstract":"<jats:p>Introduction: Current KDIGO guidelines for IgA nephropathy (IgAN) recommend proteinuria should be maintained at &lt;0.5 g\/day. In this study, we aimed to evaluate the association of proteinuria target achievement timing and stability with adverse kidney outcomes. Methods: A cohort study was conducted with IgAN patients at Peking University First Hospital. We introduced three metrics: the timing of proteinuria first to target (TTT) in part A, time in target range (TTR), and area out of target (AOT) of proteinuria in part B to describe target achievement timing and stability, respectively. The target of proteinuria was less than 0.5 g\/day. We analyzed the association between those three metrics and the composite kidney outcome, which was defined as the first occurrence of either end-stage kidney disease or a &gt;50% decrease in estimated glomerular filtration rate from baseline. Results: In part A, the primary outcome occurred in 166 (18.65%) patients. The 10-year kidney survival probability was 73% in TTT &lt;6 months of group and 64% in TTT \u22656 months of group (p = 0.006). We identified a significant association between the rate of initial target achievement and clinical outcomes. In part B, the primary outcome occurred in 385 (23.21%) patients. The 10-year kidney survival probability was 45% in T1 (TTR = 0%), 60% in T2 (0%&lt; TTR \u226450%), and 86% in T3 (50%&lt; TTR \u2264100%) groups (p &lt; 0.001). The corresponding hazard ratios (95% CI) for the respective proteinuria-TTR categories were 0.54 (0.43\u20130.68) and 0.21 (0.15\u20130.31), respectively. Our results demonstrate that maintaining stable target-range duration strongly correlated with improved prognosis. Our further analysis using a restricted cubic spline model indicated that the association of TTR and primary outcome generally showed a linear relationship. The analysis of AOT showed consistent results. Conclusion: Our study supports the importance of rapidly reaching proteinuria remission (&lt;6 months) and maintaining proteinuria within this target range for an extended period.<\/jats:p>","DOI":"10.1159\/000547868","type":"journal-article","created":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T16:00:57Z","timestamp":1754496057000},"page":"409-425","source":"Crossref","is-referenced-by-count":4,"title":["The Association of Proteinuria Target Achievement Timing and Stability with Adverse Kidney Outcomes among Patients with IgA Nephropathy: A Cohort Study"],"prefix":"10.1159","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-4240-8151","authenticated-orcid":false,"given":"Run","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miao","family":"Hui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duoduo","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7225-9105","authenticated-orcid":false,"given":"Chen","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7215-707X","authenticated-orcid":false,"given":"Xujie","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sufang","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijun","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jicheng","family":"Lv","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2025,8,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.2215\/cjn.0000000000000135"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2021.04.003"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2022.12.014"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfr527"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2023.12.016"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2102953"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-023-00476-9"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2016.02.042"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2021.03.007"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2020.08.003"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2023.09.020"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(23)00569-x"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1681\/asn.0000000000000242"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2023.09.027"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2022.01.010"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2024.05.015"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1651587"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfae252"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1681\/asn.2007050526"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(23)01554-4"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2022.05.017"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2014.63"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2009.168"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1161\/hypertensionaha.122.20141"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1038\/s41581-024-00885-3"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1681\/asn.2020030349"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.2215\/cjn.08600718"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1161\/hypertensionaha.122.20711"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.01.014"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2023.12.008"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.5368"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2021.05.021"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfq665"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1023\/b:Thro.0000011377.78585.63"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2009.243"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2017.02.003"}],"container-title":["American Journal of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/000547868","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T16:00:59Z","timestamp":1784563259000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000547868"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,6]]},"references-count":36,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,7,20]]},"published-print":{"date-parts":[[2026,8,5]]}},"URL":"https:\/\/doi.org\/10.1159\/000547868","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.29838857","asserted-by":"subject"}]},"ISSN":["0250-8095","1421-9670"],"issn-type":[{"value":"0250-8095","type":"print"},{"value":"1421-9670","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,6]]}}}