Nephrology Month in Review: February 2024

Though it was just the second month in the new year, February was an important month in nephrology and a strong predictor of developments to come in renal care. Our month in review spotlights some of HCPLive’s top coverage from the past few weeks, ranging from research about the identification and management of immunoglobulin A nephropathy (IgAN), new insight about the impact of hepatitis C virus (HCV) infection and potentially inappropriately prescribed medications among patients on dialysis, to other factors impacting renal care.

IgAN Identification, Management

NanoString mRNA Profiling Identifies Inflammatory, Fibrotic Markers of IgA Nephropathy

Patients with IgAN may have a distinctive gene expression profile that is further altered by the presence of fibrosis. As such, NanoString technology may be a viable tool for identifying inflammatory targets related to IgAN disease progression, with findings from this study identifying a significant upregulation of C3 and TNFRSF1B in patients with IgAN compared to healthy controls. Additionally, further analysis revealed certain mRNA transcripts may also have utility as fibrotic markers, including PTEN, CASPASE 3, TGM2, TGFB1, IL2, and TNFRSF1B.

Hydroxychloroquine, Leflunomide Improve Proteinuria, Renal Function in IgAN

Results from a single-center retrospective analysis of patients with primary IgAN showed hydroxychloroquine more effectively reduced proteinuria while leflunomide demonstrated superiority for hematuria reduction. However, the combination of both immunosuppressants with a renin-angiotensin system inhibitor (RASi) was more effective in improving proteinuria and stabilizing renal function compared to using a RASi alone.

How 72-Week Data Informs Nephrologists on Potential of Atacicept in IgA Nephropathy, with Richard Lafayette, MD

In this Q&A, Richard Lafayette, MD, professor of medicine and director of the Stanford Glomerular Disease Center at Stanford University Medical Center, discusses how the 72-week ORIGIN OLE data further informs nephrologists on the potential effects of atacicept in patients with IgAN. Announced by Vera Therapeutics on January 25, 2024, results suggest those treated with atacicept for 72 weeks experienced a 62% reduction in Gd-IgA1, a reduction in the percentage of participants with hematuria to 19%, and a 48% reduction in UPCR in the per-protocol analysis.

“With this program with the B-cell modifying drug, combined BAFF and APRIL, we do see an early and, now, sustained signal of GFR preservation,” Lafayette said. “Again, that's what the bar will be for full approval for sure and the fact that this extension study now takes these patients all the way to 72 weeks and takes another group of brand-new patients that show stabilization of GFR out to nine months, it just makes the risk very, very much lower, that phase 3 won't work.”

Challenges Hindering Care, Outcomes for Patients on Dialysis

HCV Prevalence, Fatality Greater Among Dialysis Patients, Especially Those on Hemodialysis

Seeking to address the lack of epidemiological data that can map the pooled global prevalence of HCV in dialysis patients, this ​​systematic review and meta-analysis included more than 600 articles and found a 24.3% worldwide prevalence rate and a 38.7% case fatality rate in this susceptible patient population. Further analysis revealed significant differences based on the type of dialysis, with an increased prevalence observed among patients on hemodialysis (P = .001), and HCV diagnostic method, noting an increased prevalence when using indirect ELISA (P = .003).

Inappropriate Medications Prescribed Among Patients on Dialysis

Contraindicated, supra-therapeutically dosed, or potentially unnecessary medications are commonly prescribed to patients with end-stage kidney disease receiving maintenance hemodialysis. Findings from this retrospective longitudinal cohort study of patients in the United States Renal Data Systems database revealed 29.6% of patients who initiated hemodialysis in 2018 were receiving potentially inappropriately prescribed medications and by the end of the first year, 21.9% were still receiving these medications, most commonly gabapentin (5.2%; 95% CI, 5.0-5.4%), hydrochlorothiazide (4.6%; 95% CI, 4.4-4.8%), famotidine (3.6%; 95% CI, 3.4-3.8%).

Factors Impacting Renal Care

Neighborhood Segregation Linked to Racial Disparities in Access to Live Donor Kidney Transplantation

Neighborhood segregation at both the residential and transplant center level may have a notable impact on transplant candidates’ access to live donor kidney transplantation. According to findings published in JAMA Internal Medicine, Black transplant candidates living in a high-segregation neighborhood had 10% (adjusted hazard ratio [aHR], 0.90; 95% CI, 0.84-0.97) lower access to live donor kidney transplantation relative to those residing in a low-segregation neighborhood. Regardless of race, candidates listed at transplant centers located in high-segregation neighborhoods had significantly lower access to living donor transplantation compared to those in low-segregation transplant center neighborhoods (aHR, 0.81; 95% CI, 0.78-0.84).

AWAKEN: Recurrent Neonatal AKI Linked To Longer Hospital Stay Than Single Episode

Previously, the dangers of recurrent neonatal acute kidney injury (AKI) were not well documented and thus poorly understood. This secondary analysis of the Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) study provides novel evidence of adverse outcomes, namely longer hospitalization, in neonates with multiple episodes of AKI compared to those experiencing a single episode. Additionally, younger gestational age, lower birthweight, and a more severe initial AKI episode were identified as risk factors for recurrent AKI.