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Immediate therapeutic efficacy of low-density lipoprotein apheresis for drug-resistant nephrotic syndrome: evidence from the short-term results from the POLARIS Study

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Abstract

Background

Hyperlipidemia is not merely a complication but a major exacerbating factor in longstanding nephrotic syndrome (NS). Low-density lipoprotein apheresis (LDL-A) has been reported to ameliorate dyslipidemia and induce rapid remission of NS. Several clinical studies have suggested the therapeutic efficacy of LDL-A, but the level of clinical evidence is insufficient. Therefore, a multicenter prospective study, POLARIS (Prospective Observational Survey on the Long-Term Effects of LDL Apheresis on Drug-Resistant Nephrotic Syndrome), was initiated in Japan.

Method

Patients with drug-resistant NS were prospectively recruited into the study and treated with LDL-A in facilities that were registered in advance. In the POLARIS study design, the clinical data are to be followed up for 2 years. In the current study, we aimed at evaluating the short-term efficacy based on the treatment outcome of LDL-A immediately after completion of treatment.

Results

Along with rapid improvement of hyperlipidemia, LDL-A significantly improved proteinuria and hypoproteinemia after treatment. More than half of the patients showed remission of NS based on the urinary protein level at the completion of LDL-A. The duration of NS before the start of treatment was significantly shorter in patients who responded to LDL-A.

Conclusions

An analysis of patients registered in the POLARIS study indicated that LDL-A has short-term efficacy for drug-resistant NS. Rapid relief of dyslipidemia by LDL-A may provide early remission in about half of the NS patients who are resistant to conventional medication. Completion of the POLARIS study may reveal additional long-term effects of LDL-A in these patients.

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Acknowledgments

This study was supported by The Kidney Foundation, Japan and in part by a grant in relation to Progressive Renal Disease from the Ministry of Health, Labor and Welfare Research Project for Specially Selected Disease. The authors express their appreciation to all the investigators who reported clinical data in this study, including Atsushi Oyama (Nishi-Kobe Medical Center), Noriaki Henmi (Fukaya Red Cross Hospital), Noriko Mori (Shizuoka General Hospital), Osamu Nishi, (Nishi Clinic), Yasukiyo Mori (Kyoto Prefectural University of Medicine), Megumu Fukunaga (Toyonaka Municipal Hospital), Masahiko Miyamoto (Osaka Red Cross Hospital), Kenji Arizono (Kumamoto Chuo Hospital), Takako Suzuki (Moriyama Rehabilitation Hospital), Kazuhiko Hora (Hokushin General Hospital), Hiroshi Makino (Okayama University), Hideyasu Kiyomoto (Kagawa University), Yutaka Ando (Osaka Minami Medical Center), Yoshiharu Tsubakihara (Osaka General Medical Center), Kosuke Ota (Okayama Medical Center), Masamichi Fukuda (Iwakuni Medical Center Hospital), Yukiko Abe (Shin-Oura Hospital), Mitsuhiro Yoneda (Fuke Chiba Hospital), Hiroshi Ohtani (Akita Kumiai General Hospital), Tokuichiro Sugimoto (Mitsui Memorial Hospital), Shizunori Ichida (Japanese Red Cross Nagoya Daiichi Hospital), Kentaro Wada (Nippon Kokan Fukuyama Hospital), Rhosuke Yoshihara (Konan Kakogawa Hospital), Shoichi Fujimoto (University of Miyazaki), Morihiro Kondo (Rakuwa-kai Otowa Hospital), Takeshi Nakanishi (Hyogo College of Medicine), Kazuhiko Tsuruya (Kyusyu University), Fumiki Tanigawa (Shimonoseki Kosei Hospital), Masami Hashimoto (Onomichi General Hospital), Akiko Nakamura (Saga Prefectural Hospital Koseikan), Soshi Yorifuji (Osaka Saiseikai Nakatsu Hospital), Tamaki Sasaki (Kawasaki Medical School).

Conflict of interest

None of the authors report a conflict of interest with this study.

Author information

Authors and Affiliations

  1. Division of Nephrology and Dialysis, Kitano Hospital, Tazuke Kofukai Medical Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan

    Eri Muso

  2. Ryoshukai Takaishi Fujii Hospital, Takaishi, Japan

    Masatoshi Mune

  3. Department of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Tokyo, Japan

    Tsutomu Hirano

  4. Department of Pediatric Nephrology, Tokyo Women’s Medical University, Tokyo, Japan

    Motoshi Hattori

  5. Department of Nephrology and Hypertension, Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan

    Kenjiro Kimura

  6. Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, Fukushima, Japan

    Tsuyoshi Watanabe

  7. Division of Nephrology, Kanazawa Medical University School of Medicine, Uchinada, Japan

    Hitoshi Yokoyama

  8. Department of Clinical Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan

    Hiroshi Sato

  9. Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan

    Shunya Uchida

  10. Department of Laboratory Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan

    Takashi Wada

  11. Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan

    Tetsuo Shoji & Yoshiki Nishizawa

  12. Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan

    Yukio Yuzawa

  13. Department of Pediatrics, Kinki University School of Medicine, Osaka-Sayama, Japan

    Tsukasa Takemura

  14. Division of Nephrology, Kanayama Clinic, Nagoya, Japan

    Satoshi Sugiyama

  15. Division of Nephrology and Rheumatology, Department of Internal Medicine, Fukuoka University, Fukuoka, Japan

    Satoru Ogahara

  16. Department of Advanced Nephrology, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan

    Noriaki Yorioka

  17. The Kidney Foundation, Japan, Tokyo, Japan

    Soichi Sakai & Yosuke Ogura

  18. Nakayamadera Imai Clinic, Takarazuka, Japan

    Enyu Imai

  19. Wakayama KD Clinic, Wakayama, Japan

    Susumu Yukawa

  20. Department of Nephrology, Nippon Medical School, Tokyo, Japan

    Yasuhiko Iino

  21. Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Seiichi Matsuo

  22. Faculty of Medicine, General Medical Research Center, Fukuoka University, Fukuoka, Japan

    Takao Saito

Authors
  1. Eri Muso
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  2. Masatoshi Mune
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  3. Tsutomu Hirano
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  4. Motoshi Hattori
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  9. Shunya Uchida
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  14. Satoshi Sugiyama
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  15. Yoshiki Nishizawa
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  16. Satoru Ogahara
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  17. Noriaki Yorioka
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  18. Soichi Sakai
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  19. Yosuke Ogura
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  20. Susumu Yukawa
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  21. Yasuhiko Iino
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  22. Enyu Imai
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  23. Seiichi Matsuo
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  24. Takao Saito
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Corresponding author

Correspondence to Eri Muso.

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Muso, E., Mune, M., Hirano, T. et al. Immediate therapeutic efficacy of low-density lipoprotein apheresis for drug-resistant nephrotic syndrome: evidence from the short-term results from the POLARIS Study. Clin Exp Nephrol 19, 379–386 (2015). https://doi.org/10.1007/s10157-014-0996-8

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  • DOI: https://doi.org/10.1007/s10157-014-0996-8

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