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Better remission rates in elderly Japanese patients with primary membranous nephropathy in nationwide real-world practice: The Japan Nephrotic Syndrome Cohort Study (JNSCS).

Authors :
Yokoyama, Hitoshi
Yamamoto, Ryohei
Imai, Enyu
Maruyama, Shoichi
Sugiyama, Hitoshi
Nitta, Kosaku
Tsukamoto, Tatsuo
Uchida, Shunya
Takeda, Asami
Sato, Toshinobu
Wada, Takashi
Hayashi, Hiroki
Akai, Yasuhiro
Fukunaga, Megumu
Tsuruya, Kazuhiko
Masutani, Kosuke
Konta, Tsuneo
Shoji, Tatsuya
Hiramatsu, Takeyuki
Goto, Shunsuke
Source :
Clinical & Experimental Nephrology. Oct2020, Vol. 24 Issue 10, p893-909. 17p.
Publication Year :
2020

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. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
13421751
Volume :
24
Issue :
10
Database :
Academic Search Index
Journal :
Clinical & Experimental Nephrology
Publication Type :
Academic Journal
Accession number :
145889394
Full Text :
https://doi.org/10.1007/s10157-020-01913-9