Kidney Week

Abstract: SA-PO1145

Application of Functional Kidney Magnetic Resonance Imaging to Improve Assessment of CKD: The AFiRM Study

Session Information

• CKD: Patient-Oriented Care and Case Reports
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Selby, Nicholas M., University of Nottingham, Nottingham, Nottinghamshire, United Kingdom

Nicholas M. Selby, MD, MBBS

• Gilthorpe, Mark S., Leeds Beckett University, Leeds, Yorkshire, United Kingdom

Mark S. Gilthorpe

• Kalra, Philip A., Salford Royal Hospital Manchester Centre for Clinical Neurosciences, Salford, Greater Manchester, United Kingdom

Philip A. Kalra, MD, MBChB

• Mendichovszky, Iosif A., Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom

Iosif A. Mendichovszky, MD, PhD

• Sourbron, Steven, The University of Sheffield, Sheffield, United Kingdom

Steven Sourbron, PhD

• Taal, Maarten W., University of Nottingham, Nottingham, Nottinghamshire, United Kingdom

Maarten W. Taal, MD, MBChB

• Francis, Susan, University of Nottingham, Nottingham, Nottinghamshire, United Kingdom

Susan Francis, PhD

Group or Team Name

• On behalf of the AFiRM Investigators.

Background

Current kidney imaging techniques for chronic kidney disease (CKD) are limited. Better methods that can determine cause and prognosis of kidney diseases are required for improved patient stratification, targeting of therapies and new drug development. Renal multiparametric MRI provides whole kidney structural and functional measurements, assessing multiple aspects of kidney pathophysiology including altered tissue microstructure (inflammation/fibrosis), oxygenation and perfusion. The AFiRM study is a UK multi-centre study to evaluate the utility of multiparametric renal MRI to study CKD progression. This abstract describes the study design and baseline study population characteristics.

Methods

AFiRM is a prospective cohort study of people with CKD across 10 UK centres, collecting renal multiparametric MRI (comprising MRI measures of morphology, microstructure, flow and perfusion) at baseline and Year 2. Inclusion criteria include eGFR <60ml/min/1.73m², or persistent albuminuria (ACR >30mg/mmol). Annual follow-up visits collect eGFR, albuminuria and change in clinical status until Year 4. Long-term outcomes will be determined with individual patient tracking via the UK Renal Registry to ten years. Cause and effect between the renal MRI measures (alone and in combination) and the progression of CKD will be determined. A mechanistic sub-study is embedded to compare MRI measures to kidney histology.

Results

Between June 2021 and November 2023, 653 patients with CKD were screened for inclusion, of whom 421 were eligible, consented to participate and completed baseline multiparametric MRI. Mean age was 55 ± 13yrs and 64% were male. Mean eGFR was 38 ± 5ml/min/1.73m² and distribution across CKD stages was: stage G1/2 14%; stage G3A 22%; stage 3B 34%; and stage G4 30%. Albuminuria was present in 86% (A2/A3). The most common CKD aetiology was IgA nephropathy (21%), 15% had diabetic kidney disease but a large proportion (17%) had CKD of unknown cause.

Conclusion

The AFiRM study is a UK-wide multicentre clinical study of renal multiparametric MRI in people with CKD, which utilises a harmonised renal MRI acquisition, centralised image upload and quality assurance, and analysis.

Funding

• Government Support – Non-U.S.