Better remission rates in elderly Japanese patients with primary membranous nephropathy in nationwide real-world practic
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ORIGINAL ARTICLE
Better remission rates in elderly Japanese patients with primary membranous nephropathy in nationwide real‑world practice: The Japan Nephrotic Syndrome Cohort Study (JNSCS) Hitoshi Yokoyama1 · Ryohei Yamamoto2 · Enyu Imai3 · Shoichi Maruyama4 · Hitoshi Sugiyama5 · Kosaku Nitta6 · Tatsuo Tsukamoto7 · Shunya Uchida8 · Asami Takeda9 · Toshinobu Sato10 · Takashi Wada11 · Hiroki Hayashi12 · Yasuhiro Akai13 · Megumu Fukunaga14 · Kazuhiko Tsuruya13,15 · Kosuke Masutani16 · Tsuneo Konta17 · Tatsuya Shoji18 · Takeyuki Hiramatsu19 · Shunsuke Goto20 · Hirofumi Tamai21 · Saori Nishio22 · Arimasa Shirasaki23 · Kojiro Nagai24 · Kunihiro Yamagata25 · Hajime Hasegawa26 · Hidemo Yasuda27 · Shizunori Ichida28 · Tomohiko Naruse29 · Kei Fukami30 · Tomoya Nishino31 · Hiroshi Sobajima32 · Satoshi Tanaka33 · Toshiyuki Akahori34 · Takafumi Ito35 · Yoshio Terada36 · Ritsuko Katafuchi37 · Shouichi Fujimoto38 · Hirokazu Okada39 · Eiji Ishimura40 · Junichiro James Kazama41 · Keiju Hiromura42 · Tetsushi Mimura43 · Satashi Suzuki44 · Yosuke Saka45 · Tadashi Sofue46 · Yusuke Suzuki47 · Yugo Shibagaki48 · Kiyoki Kitagawa49 · Kunio Morozumi50 · Yoshiro Fujita51 · Makoto Mizutani52 · Takashi Shigematsu53 · Kengo Furuichi1 · Keiji Fujimoto1 · Naoki Kashihara54 · Hiroshi Sato55 · Seiichi Matsuo3 · Ichiei Narita56 · Yoshitaka Isaka57 Received: 1 February 2020 / Accepted: 2 June 2020 © Japanese Society of Nephrology 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 nonelderly 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 immun
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