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Lookup NU author(s): Professor Neil SheerinORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
Introduction. Chronic kidney disease (CKD) has major population health implications, but current imaging approaches provide limited pathophysiological insights. We designed a study to evaluate renal multiparametric MRI (mpMRI) as a tool to improve diagnosis, risk stratification, disease monitoring, and therapeutic decision-making in CKD. Methods. The AFiRM study (NCT04238299) is a multicentre, prospective, observational cohort study in people with CKD. Participants undergo renal mpMRI using the harmonised cross-vendor UKRIN-MAPS protocol at baseline and at 2-years. Clinical data are collected annually for four years with kidney failure outcomes assessed at 10 years. Primary objectives are to determine associations between MRI measures of kidney morphology, inflammation, fibrosis, perfusion and oxygenation with CKD progression, and to quantify longitudinal changes in mpMRI measures. A biopsy sub-study compares mpMRI measures with histology to explore mechanistic processes including fibrosis. Results. Across nine centres, 420 participants (biopsy sub-study n=43) completed baseline assessments and mpMRI. Mean age is 55 years (SD 13) and 63.8% are male. Median eGFR is 39ml/min/1.73m2 (IQR 29 - 53), median uACR 47mg/mmol (IQR 8.3 to 127.1), and median 5-year Kidney Failure Risk Equation score is 5.6% (IQR 1.0-20.8%). Most common CKD aetiologies are IgA nephropathy (22.4%), CKD of unknown aetiology (19.5%), and diabetic kidney disease (14.3%). Biopsy sub-study participants were demographically similar to the full cohort. Conclusion. The AFiRM study has established a representative CKD cohort undergoing advanced renal mpMRI with long-term follow-up. This is an important resource to study how renal MRI measures and their longitudinal changes relate to CKD severity and progression.
Author(s): Francis S, Buchanan CED, Chester V, Cox EF, Craig M, Dhaun N, Daniel AJ, Gilthorpe M, Gillis KA, Hall M, Judge P, Kalra PA, Lewington A, Mendichovszky IA, Morris D, Priest AN, Sheerin NS, Sherman R, Sourbron S, Taal MW, Thomas DL, Selby NM
Publication type: Article
Publication status: Published
Journal: Kidney International Reports
Year: 2026
Pages: Epub ahead of print
Online publication date: 16/05/2026
Acceptance date: 04/05/2026
Date deposited: 27/05/2026
ISSN (electronic): 2468-0249
Publisher: Elsevier Inc.
URL: https://doi.org/10.1016/j.ekir.2026.106594
DOI: 10.1016/j.ekir.2026.106594
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