Presentation (CTI)

OBJECTIVES: Immunoglobulin A nephropathy (IgAN) is a progressive renal condition and a leading cause of kidney failure globally. Proteinuria is among the strongest predictors of IgAN progression, yet current available therapies often fall short of achieving lower targets. International guidelines recommend early risk stratification and timely access to disease-specific therapies. In Ireland, clinical practice frequently remains misaligned with these recommendations due to systemic and policy-level barriers, particularly around delayed access and reimbursement of newer treatments.Objective: To explore the disparity between international guideline recommendations and real-world management of IgAN in Ireland, focusing on treatment availability, reimbursement pathways, and timely access.
METHODS: A narrative synthesis was conducted using: (1) comparative review of published guidelines and Irish clinical practice, (2) a targeted search of treatment access and reimbursement status in Ireland, and (3) qualitative input from nephrologists and stakeholders. Publicly available data and policy documents were analysed to identify key gaps and barriers in care delivery.
RESULTS: Although RAASi and SGLT2 inhibitors are accessible and utilised in eligible IgAN patients, other new disease-modifying therapies, such as targeted-release budesonide and dual endothelin angiotensin receptor antagonist (DEARA), are not yet reimbursed in Ireland and therefore remain inaccessible in routine clinical practice. National guidelines reflecting the latest international evidence have not been implemented, and fragmented care pathways continue to delay optimal treatment. These barriers contribute to prolonged conservative patient management, with suboptimal control of disease progression and increasing long-term clinical and economic burden on patients and the healthcare system.
CONCLUSIONS: A clear unmet need exists in IgAN in Ireland, driven by limited reimbursement of novel treatments and a lack of alignment with international standards. Developing national guidance aligned with international evidence, alongside streamlined reimbursement processes and expanded access to evidence-based therapies, is crucial for improving patient outcomes and reducing future burden on the healthcare system.