WCN26-5943 High Diagnostic Yield of Genetic Testing in End-Stage Kidney Disease: Insights from a Large Chinese Cohort

improve risk stratification and guide targeted, personalised interventions and enrich trial recruitment.Methods: This study was conducted at a metropolitan tertiary centre in Brisbane, Australia.All patients known to the Kidney Health service with a biopsy proven IgA nephropathy from January 2010 -August 2025 were included for analysis.Additional cases were identified by screening hospital admissions for relevant ICD-10 codes (e.g.N02.8: recurrent/persistent haematuria/IgA nephropathy; D69.0: Henoch-Schnlein purpura), followed by review of kidney biopsy.Results: A total of 153 patients met inclusion criteria; 100 (65%) were male.At diagnosis, the median age was 43 years 3), median eGFR was 52 mL/min/1.73m 2 (IQR 27.5-87), and median proteinuria was 1.95 g/24 h (IQR 0.77-3.73).The mean follow-up duration was 60.7 months (median 47.4,IQR 23.0-89.1).Among 88 patients with $3 years of follow-up, the overall mean change eGFR slope was -2.12 mL/min/1.73m 2 /year.Patients with <1 g/day proteinuria (n = 29) had a mean change in slope of -2.09 mL/ min/1.73m 2 /year (95% CI -4.31 to 0.13), while those with >1 g/day proteinuria (n = 55) had a mean slope of -2.62 mL/min/1.73m 2 /year (95% CI -4.18 to -1.07);There was no statistically significant difference between these groups (Welch's t-test: p = 0.691).Within the cohort with >1 g/day proteinuria, 27 patients treated with immunosuppression had available 3-year eGFR data.Their mean baseline eGFR was 61.7 mL/min/1.73m 2 (95% CI 51.6-71.9),and their mean slope was -3.02 mL/min/1.73m 2 /year (95% CI -4.71 to -1.34).In comparison, 28 patients who did not receive immunosuppression had a mean baseline eGFR of 60.0 mL/min/1.73m 2 (95% CI 49.3-70.3)and a slope of -2.24 mL/min/1.73m 2 /year (95% CI -4.93 to 0.46).The difference between treated and untreated groups was not statistically significant (Welch's t-test: p = 0.62).Overall, 43 of 153 patients (28%) experienced >50% eGFR decline during follow-up, with a median time to event of 31.3 months; 24 of 153 patients (16%) had documented clinical features of IgA vasculitis, 6 (25%) of whom experienced >50% eGFR decline during follow-up, with a mean time to event of 37.9 months.Male patients were more likely to experience event (35% vs 15%; RR 2.32, 95% CI 1.16-4.64;p=0.009).Conclusion: IgA nephropathy remains an aggressive disease with considerable impact on health of people living with the disease in Australia.Despite a significant proportion of patients experiencing decline in kidney function, baseline proteinuria or eGFR does not reliably distinguish those with rapid progression.These results highlight the limitations proteinuria as a predictor of clinical outcome in real-world practice and underscore the need for improved risk stratification strategies to identify high-risk patients and optimise early intervention.I have no potential conflict of interest to disclose.I did not use generative AI and AI-assisted technologies in the writing process.