@article{1a7299ddb714497093b72c8c33c0f2e3,
title = "Improving treatment decisions using personalized risk assessment from the International IgA Nephropathy Prediction Tool",
abstract = "Immunosuppression in IgA nephropathy (IgAN) should be reserved for patients at high-risk of disease progression, which KDIGO guidelines determine based solely on proteinuria 1g or more/day. To investigate if treatment decisions can be more accurately accomplished using individualized risk from the International IgAN Prediction Tool, we simulated allocation of a hypothetical immunosuppression therapy in an international cohort of adults with IgAN. Two decision rules for treatment were applied based on proteinuria of 1g or more/day or predicted risk from the Prediction Tool above a threshold probability. An appropriate decision was defined as immunosuppression allocated to patients experiencing the primary outcome (50% decline in eGFR or ESKD) and withheld otherwise. The net benefit and net reduction in treatment are the proportion of patients appropriately allocated to receive or withhold immunosuppression, adjusted for the harm from inappropriate decisions, calculated for all threshold probabilities from 0-100%. Of 3299 patients followed for 5.1 years, 522 (15.8%) experienced the primary outcome. Treatment allocation based solely on proteinuria of 1g or more/day had a negative net benefit (was harmful) because immunosuppression was increasingly allocated to patients without progressive disease. Compared to using proteinuria, treatment allocation using the Prediction Tool had a larger net benefit up to 23.4% (95% confidence interval 21.5-25.2%) and a larger net reduction in treatment up to 35.1% (32.3-37.8%). Thus, allocation of immunosuppression to high-risk patients with IgAN can be substantially improved using the Prediction Tool compared to using proteinuria.",
keywords = "IgA nephropathy, decision curve, immunosuppression, net benefit, renal progression, treatment allocation",
author = "{International IgA Nephropathy Network} and Barbour, {Sean J.} and Mark Canney and Rosanna Coppo and Hong Zhang and Liu, {Zhi Hong} and Yusuke Suzuki and Keiichi Matsuzaki and Ritsuko Katafuchi and Dilshani Induruwage and Lee Er and Reich, {Heather N.} and John Feehally and Jonathan Barratt and Cattran, {Daniel C.} and Russo, {M. L.} and S. Troyanov and Cook, {H. T.} and I. Roberts and V. Tesar and D. Maixnerova and S. Lundberg and L. Gesualdo and F. Emma and L. Fuiano and G. Beltrame and C. Rollino and A. Amore and R. Camilla and L. Peruzzi and M. Praga and S. Feriozzi and R. Polci and G. Segoloni and L. Colla and A. Pani and D. Piras and A. Angioi and G. Cancarini and S. Ravera and M. Durlik and E. Moggia and J. Ballarin and {Di Giulio}, S. and F. Pugliese and I. Serriello and Y. Caliskan and M. Sever and I. Kilicaslan and F. Fervenza and A. Massat",
note = "Funding Information: SJB is a Scholar with the Michael Smith Foundation for Health Research . Funding support for this project was provided by grant funding from the Canadian Institutes of Health Research ( PCG-155557 ). The VALIGA study was supported by a grant from the first research call and the Immunonephrology Working Group of the European Renal Association–European Dialysis and Transplant Association. The Oxford derivation and North American Validation studies were supported by the International IgA Nephropathy Network , the Toronto GN Registry, and the Toronto General Hospital Foundation (McCann Fund). The funders had no role in the design and conduct of the study, in the collection, management, analysis, and interpretation of the data, in the preparation, review, and approval of the manuscript, or the decision to submit the manuscript for publication. Funding Information: SJB is a Scholar with the Michael Smith Foundation for Health Research. Funding support for this project was provided by grant funding from the Canadian Institutes of Health Research (PCG-155557). The VALIGA study was supported by a grant from the first research call and the Immunonephrology Working Group of the European Renal Association?European Dialysis and Transplant Association. The Oxford derivation and North American Validation studies were supported by the International IgA Nephropathy Network, the Toronto GN Registry, and the Toronto General Hospital Foundation (McCann Fund). The funders had no role in the design and conduct of the study, in the collection, management, analysis, and interpretation of the data, in the preparation, review, and approval of the manuscript, or the decision to submit the manuscript for publication. SJB, MC, DI, LE, HNR, and DCC designed the study and analytic plan. All analyses were performed by DI and LE. Data were contributed by RC, HZ, ZHL, YS, KM, RK, HNR, and DCC. All authors reviewed the results, drafted and revised the paper, and approved the final manuscript. Each author accepts personal accountability for the author's own contributions and agrees to ensure that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. Publisher Copyright: {\textcopyright} 2020 International Society of Nephrology",
year = "2020",
month = oct,
doi = "10.1016/j.kint.2020.04.042",
language = "English (US)",
volume = "98",
pages = "1009--1019",
journal = "Kidney International",
issn = "0085-2538",
publisher = "Nature Publishing Group",
number = "4",
}