What question did this study set out to answer?

To investigate the relationship between variability in glomerular area and adverse kidney outcomes in IgA nephropathy.

March 28, 2026Open Access

WCN26-4629 Variability in Glomerular Area and Adverse Kidney Outcomes in IgA Nephropathy

Key Points

To investigate the relationship between variability in glomerular area and adverse kidney outcomes in IgA nephropathy.
Conducted a systematic review and meta-analysis of randomized controlled trials (RCTs).
Searched multiple databases including MEDLINE and EMBASE for relevant studies.
Evaluated primary outcomes such as all-cause mortality and cardiovascular events.
Assessed risk of bias using the Cochrane tool and certainty of evidence through the GRADE approach.
No significant difference in all-cause mortality or cardiovascular events between intervention and control groups.
Point estimates suggested a possible increase in cardiovascular risk after RASi discontinuation.
The evidence certainty was rated as very low due to risk of bias and clinical heterogeneity.

Abstract

registry archives to comprehensively examine the current landscape of the effects of RASi discontinuation.Methods: We performed a systematic review and meta-analysis including only RCTs.We searched MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov,and EU Clinical Trials Register for the full text review analysis on 21 September 2025.Primary outcomes included allcause death and cardiovascular (CVD) events.Risk of bias was assessed using version 2 of the Cochrane Risk of bias tool, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach.Results: Among the seven included RCTs (n = 928), four studies (n = 745) reported all-cause mortality and two studies (n = 697) reported CVD events.The meta-analysis did not show a difference in all-cause mortality (RR 0.95, 95% CI 0.54-1.65;I 2 = 0%) and cardiovascular events (RR 1.22, 95% CI 1.00-1.50;I 2 = 0%) between the intervention and control groups.The certainty of evidence was rated as very low for both outcomes because of risk of bias, imprecision, and clinical heterogeneity.Conclusion: This systematic review and meta-analysis did not identify a statistical difference in the risk of all-cause mortality or CVD events following RASi discontinuation compared with continuation.However, the point estimates suggested a potential increase in cardiovascular risk after discontinuation, which may be mediated by changes in blood pressure.The certainty of evidence was very low; thus, the results should be interpreted with caution.Further high-quality RCTs are warranted to clarify the clinical implications.I have no potential conflict of interest to disclose.I used generative AI and AI-assisted technologies in the writing process.

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