Better remission rates in elderly Japanese patients with primary membranous nephropathy in nationwide real-world practice: The Japan Nephrotic Syndrome Cohort Study (JNSCS)
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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DOI：
10.1007/s10157-020-01913-9
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发表时间：
2020-06-19
影响因子：
2.3
通讯作者：
Isaka, Yoshitaka
中科院分区：
文献类型：
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作者：
Yokoyama, Hitoshi;Yamamoto, Ryohei;Isaka, Yoshitaka
背景：本研究的目的是阐明日本全国范围内的免疫抑制药物在老年和非老年原发性膜性肾病(MN)患者中的使用情况和预后。患者和方法2009-2010年间，374例原发性肾病综合征患者纳入队列研究(日本肾病综合征队列研究，JNSCS)，包括126例成人MN患者。将他们的临床特征与在全国范围内登记(日本肾活检登记处，J-RBR)登记的原发性MN肾病患者进行比较。确定了老年组(65岁)和非老年组的结果和预测因素。结果JNSCS患者与J-RBR患者(n=1808)具有相似的临床特征。在1个月早期，84.1%的患者接受了免疫抑制治疗。不同年龄组之间的治疗方法没有显著差异。然而，老年患者比非老年患者更容易获得完全缓解(CR)，特别是那些接受包括皮质类固醇在内的治疗的患者。不同年龄组之间在血肌酐(Scr)升高50%或100%、终末期肾病或全因死亡率方面没有显著差异。在多变量COX模型中，皮质类固醇被确定为CR的独立预测因素(HR 2.749，95%CI 1.593-4.745，p=0.000)。Scr水平、血红蛋白水平、免疫抑制剂、临床缓解和CR后复发是Scr x 1.5或x 2.0的独立预测因素。结论在一项全国性的队列研究中，包括糖皮质激素在内的早期免疫抑制治疗对老年MN患者有较好的缓解率。
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 x 1.5 or x 2.0. Conclusion Early immunosuppressive therapy including corticosteroids for primary MN showed better remission rates in elderly patients in a nationwide cohort study.