Better remission rates in elderly Japanese patients with primary membranous nephropathy in nationwide real-world practice: The Japan Nephrotic Syndrome Cohort Study (JNSCS).
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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, Tamai Hirofumi, Nishio Saori, Shirasaki Arimasa, Nagai Kojiro, Yamagata Kunihiro, Hasegawa Hajime, Yasuda Hidemo, Ichida Shizunori, Naruse Tomohiko, Fukami Kei, Nishino Tomoya, Sobajima Hiroshi, Tanaka Satoshi, Akahori Toshiyuki, Ito Takafumi, Terada Yoshio, Katafuchi Ritsuko, Fujimoto Shouichi, Okada Hirokazu, Ishimura Eiji, Kazama Junichiro James, Hiromura Keiju, Mimura Tetsushi, Suzuki Satashi, Saka Yosuke, Sofue Tadashi, Suzuki Yusuke, Shibagaki Yugo, Kitagawa Kiyoki, Morozumi Kunio, Fujita Yoshiro, Mizutani Makoto, Shigematsu Takashi, Furuichi Kengo, Fujimoto Keiji, Kashihara Naoki, Sato Hiroshi, Matsuo Seiichi, Narita Ichiei, Isaka Yoshitaka
Аннотация
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.