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Japanese clinical practice patterns of primary nephrotic syndrome 2021: a web-based questionnaire survey of certified nephrologists

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Abstract

Background

With the publication of the “Evidence-Based Clinical Practice Guideline for Nephrotic Syndrome 2020,” we examined nephrologists’ adherence to the recommendations of four of its clinical questions (CQs).

Methods

This was a cross-sectional web-based survey conducted between November and December 2021. The target population comprised nephrologists certified by the Japanese Society of Nephrology who were recruited using convenience sampling. The participants answered six items regarding the four CQs about adult patients with nephrotic syndrome and their characteristics.

Results

In total, 434 respondents worked in at least 306 facilities, of whom 386 (88.9%) provided outpatient care for primary nephrotic syndrome. Of these patients, 179 (41.2%) answered that they would not measure anti- phospholipase A2 receptor antibody levels in cases of suspected primary membranous nephropathy (MN) in which kidney biopsy was not possible (CQ1). Regarding immunosuppressants as maintenance therapy after relapse of minimal change nephrotic syndrome (CQ2), cyclosporine was the most common choice (290 [72.5%] and 300 [75.0%] of 400 respondents after the first and second relapses, respectively). The most common treatment for steroid-resistant cases of primary focal segmental glomerulosclerosis (CQ3) was cyclosporine (323 of 387, 83.5%). For the initial treatment of primary MN with nephrotic-range proteinuria (CQ4), corticosteroid monotherapy was the most common choice (240 of 403, 59.6%), followed by corticosteroid and cyclosporine (114, 28.3%).

Conclusion

Gaps in recommendations and practices regarding serodiagnosis and treatment of MN (i.e., CQ1 and 4) are observed, suggesting the need to address the barriers to their insurance reimbursement and the lack of evidence behind them.

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Data availability

The data underlying this article will be shared upon reasonable request from the corresponding author.

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Acknowledgements

This study was supported in part by a Grant-in-Aid for Intractable Renal Diseases Research, Research on Rare and Intractable Diseases, and Health and Labor Sciences Research Grants from the Ministry of Health, Labour and Welfare of Japan (ID 20FC1045). This funder had no role in the design, conduct, or reporting of this study. We would like to thank Editage (www.editage.com) for the English language editing.

Author information

Author notes

  1. Takehiko Wada and Sayaka Shimizu share co-first authorship.

Authors and Affiliations

  1. Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Kanagawa, Japan

    Takehiko Wada & Masahiro Koizumi

  2. Department of Nephrology, Toranomon Hospital, Tokyo, Japan

    Takehiko Wada

  3. Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University, Kyoto, Japan

    Sayaka Shimizu

  4. Patient Driven Academic League (PeDAL), Tokyo, Japan

    Sayaka Shimizu

  5. Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan

    Sayaka Shimizu, Hiroki Nishiwaki & Noriaki Kurita

  6. Department of Cardiorenal and Cerebrovascular Medicine, Kagawa University, Kagawa, Japan

    Tadashi Sofue

  7. Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan

    Hiroki Nishiwaki

  8. Showa University Research Administration Center (SURAC), Showa University, Tokyo, Japan

    Hiroki Nishiwaki

  9. Section of Education for Clinical Research, Kyoto University Hospital, Kyoto, Japan

    Sho Sasaki

  10. Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan

    Sho Sasaki

  11. Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, Iwate, Japan

    Izaya Nakaya

  12. Division of Nephrology, Rheumatology, and Endocrinology, Tohoku University Graduate School of Medicine, Sendai, Japan

    Yuji Oe

  13. Department of Nephrology and Rheumatology, Aichi Medical University, Aichi, Japan

    Takuji Ishimoto

  14. Department of Nephrology, Kanazawa Medical University, Ishikawa, Japan

    Kengo Furuichi

  15. Department of Nephrology, Saitama Medical University, Moroyama Town, Saitama, Japan

    Hirokazu Okada

  16. Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan

    Noriaki Kurita

Authors
  1. Takehiko Wada
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  2. Sayaka Shimizu
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  3. Masahiro Koizumi
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  4. Tadashi Sofue
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  5. Hiroki Nishiwaki
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  6. Sho Sasaki
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  7. Izaya Nakaya
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  8. Yuji Oe
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  9. Takuji Ishimoto
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  10. Kengo Furuichi
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  11. Hirokazu Okada
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  12. Noriaki Kurita
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Contributions

Study concept and design: TW, SS, TI, and NK. Data collection: TW, SS, and NK. Data analysis: SS, SS, and NK. Data interpretation and manuscript preparation: TW, SS, MK, TS, HN, SS, IN, YO, TI, KF, HO, and NK.

Corresponding author

Correspondence to Takehiko Wada.

Ethics declarations

Conflict of interest

Honoraria: Hirokazu Okada (AstraZeneca, Daiichi Sankyo, Kyowa Kirin, Mitsubishi Tanabe Pharm, Torii Pharmaceutical), Noriaki Kurita (GlaxoSmithKline), Research funding: Kengo Furuichi (Chugai Pharmaceutical, Daiichi Sankyo), Hirokazu Okada (Kyowa Kirin), Subsidies or donations: Hirokazu Okada (Bayer, Chugai Pharmaceutical, Kyowa Kirin, Ono Pharmaceutical).

Ethical approval

This study was an anonymous survey of healthcare professionals to describe the practice of primary nephrotic syndrome and was considered outside the scope of the ethical review according to the Ethical Guidelines for Medical and Biological Research Involving Human Subjects [21]. The possibility of academic publication of the survey results was described at the beginning of the questionnaire, and only those who provided consent to complete the survey were included.

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Cite this article

Wada, T., Shimizu, S., Koizumi, M. et al. Japanese clinical practice patterns of primary nephrotic syndrome 2021: a web-based questionnaire survey of certified nephrologists. Clin Exp Nephrol 27, 767–775 (2023). https://doi.org/10.1007/s10157-023-02366-6

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  • DOI: https://doi.org/10.1007/s10157-023-02366-6

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