Abstract
Background
The aim of the present study was to clarify the prevalence of immunosuppressive drug use and outcomes in elderly and non-elderly patients with primary membranous nephropathy (MN) in nationwide real-world practice in Japan.
Patients and methods
Between 2009 and 2010, 374 patients with primary nephrotic syndrome were enrolled in the cohort study (The Japan Nephrotic Syndrome Cohort Study, JNSCS), including 126 adult patients with MN. Their clinical characteristics were compared with those of nephrotic patients with primary MN registered in a large nationwide registry (The Japan Renal Biopsy Registry, J-RBR). Outcomes and predictors in the elderly (≥ 65 years) and non-elderly groups were identified.
Results
Similar clinical characteristics were observed in JNSCS patients and J-RBR patients (n = 1808). At the early stage of 1 month, 84.1% of patients were treated with immunosuppressive therapies. No significant differences were observed in therapies between age groups. However, elderly patients achieved complete remission (CR) more frequently than non-elderly patients, particularly those treated with therapies that included corticosteroids. No significant differences were noted in serum creatinine (sCr) elevations at 50 or 100%, end-stage kidney disease, or all-cause mortality between age groups. Corticosteroids were identified as an independent predictor of CR (HR 2.749, 95%CI 1.593–4.745, p = 0.000) in the multivariate Cox’s model. sCr levels, hemoglobin levels, immunosuppressants, clinical remission, and relapse after CR were independent predictors of sCr × 1.5 or × 2.0.
Conclusion
Early immunosuppressive therapy including corticosteroids for primary MN showed better remission rates in elderly patients in a nationwide cohort study.
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Acknowledgements
The present study was supported in part by a Grant-in-Aid for Intractable Renal Diseases Research, Research on Rare and Intractable Diseases, Health and Labour Sciences Research Grants for the Ministry of Health, Labour, and Welfare of Japan.
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All procedures performed in the J-RBR and JNSCS involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number I386 at the Ethics Committee of Kanazawa Medical University) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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10157_2020_1913_MOESM3_ESM.pptx
Supplementary file3 Supplementary Figure legends: Relapse after the complete remission of primary membranous nephropathy in the JNSCS. No significant differences were observed in relapse after complete remission between therapies (supportive therapy, immunosuppressant therapy, and corticosteroid monotherapy) in all patients ([A]), the non-elderly group ([B]), and elderly group ([C]). (PPTX 112 kb)
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Yokoyama, H., Yamamoto, R., Imai, E. et al. Better remission rates in elderly Japanese patients with primary membranous nephropathy in nationwide real-world practice: The Japan Nephrotic Syndrome Cohort Study (JNSCS). Clin Exp Nephrol 24, 893–909 (2020). https://doi.org/10.1007/s10157-020-01913-9
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DOI: https://doi.org/10.1007/s10157-020-01913-9