Three-Year Clinical Outcomes of the First South Asian Prospective Longitudinal Observational IgA Nephropathy Cohort

The International IgA Nephropathy Network Prediction Tool Underestimates Disease Progression in Indian Patients

“…The 3-year outcomes of the prospective GRACE-IgANI cohort from south India also suggest that Indian patients have poorer renal survival. 5 Although it was not a validation study, the authors demonstrated that the IIgANN tool underestimated the risk of composite outcomes in their patients, and this was more evident in the higher risk groups. The area under the curve of the ROC curve was 0.8135, though it has not been specified which model was used for risk prediction.…”

“… 17 The original derivation and validation cohorts did not include any patients of Indian origin or from the Indian subcontinent who are known to have an aggressive disease phenotype. 4 , 5 We evaluated the performance of this prediction tool in a cohort of adult Indian patients with biopsy-proven primary IgAN. This is necessary before it can be used in clinical practice in Indian patients.…”

“…2 , 3 Ethnic/racial disparities have been reported which suggest that the disease is more aggressive in south Asians. 4 , 5 The clinical presentation ranges from incidentally detected urinary abnormalities, such as microscopic hematuria, subnephrotic proteinuria, and nephrotic-range proteinuria, to rapidly progressive glomerulonephritis with significant variability in disease course and renal survival. 1 Risk stratification is important to counsel patients and guide treatment and monitoring strategies.…”

“…12 The derivation and the validation cohorts did not include patients of South Asian ethnicity. Because they have a higher risk of rapid deterioration of renal function, 5 we aimed to assess the performance of this model in an Indian cohort.…”

Clinical Practice Patterns in IgA Nephropathy: A Global Questionnaire-Based Survey

“…Traditionally, only China, Japan, Hong Kong, South Korea, Taiwan, and certain Southeast Asian countries have been invited to participate in clinical trials with poor representation of Middle East and South Asia, particularly India, the most populated country in the world, where IgAN appears to behave differently compared to other Asian populations. 22 Access to RCTs is limited in India, now the world’s most populous country, with few trial sites mostly restricted to large centers in big cities, with poor awareness and reluctance among nephrologists impeding patient recruitment. Countries located in Middle-East Asia are consistently not represented in trials.…”