Regional variations in immunosuppressive therapy in patients with primary nephrotic syndrome

the Japan nephrotic syndrome cohort study

Ryohei Yamamoto, Enyu Imai, Shoichi Maruyama, Hitoshi Yokoyama, Hitoshi Sugiyama, Kosaku Nitta, Tatsuo Tsukamoto, Shunya Uchida, Asami Takeda, Toshinobu Sato, Takashi Wada, Hiroki Hayashi, Yasuhiro Akai, Megumu Fukunaga, Kazuhiko Tsuruya, Kosuke Masutani, Tsuneo Konta, Tatsuya Shoji, Takeyuki Hiramatsu, Shunsuke Goto & 38 others Hirofumi Tamai, Saori Nishio, Arimasa Shirasaki, Kojiro Nagai, Kunihiro Yamagata, Hajime Hasegawa, Hidemo Yasuda, Shizunori Ichida, Tomohiko Naruse, Kei Fukami, Tomoya Nishino, Hiroshi Sobajima, Satoshi Tanaka, Toshiyuki Akahori, Takafumi Ito, Terada Yoshio, Ritsuko Katafuchi, Shouichi Fujimoto, Hirokazu Okada, Eiji Ishimura, Junichiro James Kazama, Keiju Hiromura, Tetsushi Mimura, Satashi Suzuki, Yosuke Saka, Tadashi Sofue, Yusuke Suzuki, Yugo Shibagaki, Kiyoki Kitagawa, Kunio Morozumi, Yoshiro Fujita, Makoto Mizutani, Takashi Shigematsu, Naoki Kashihara, Hiroshi Sato, Seiichi Matsuo, Ichiei Narita, Yoshitaka Isaka

Research output: Contribution to journalArticle

Abstract

Background: The lack of high-quality clinical evidences hindered broad consensus on optimal therapies for primary nephrotic syndromes. The aim of the present study was to compare prevalence of immunosuppressive drug use in patients with primary nephrotic syndrome across 6 regions in Japan. Methods: Between 2009 and 2010, 380 patients with primary nephrotic syndrome in 56 hospitals were enrolled in a prospective cohort study [Japan Nephrotic Syndrome Cohort Study (JNSCS)], including 141, 151, and 38 adult patients with minimal change disease (MCD), membranous nephropathy (MN), and focal segmental glomerulosclerosis (FSGS), respectively. Their clinical characteristics were compared with those of patients registered in a large nationwide registry of kidney biopsies [Japan Renal Biopsy Registry (J-RBR)]. The regional prevalence of use of each immunosuppressive drug was assessed among adult MCD, MN, and FSGS patients who underwent immunosuppressive therapy in the JNSCS (n = 139, 127, and 34, respectively). Predictors of its use were identified using multivariable-adjusted logistic regression models. Results: The clinical characteristics of JNSCS patients were comparable to those of J-RBR patients, suggesting that the JNSCS included the representatives in the J-RBR. The secondary major immunosuppressive drugs were intravenous methylprednisolone [n = 33 (24.6%), 24 (19.7%), and 9 (28.1%) in MCD, MN, and FSGS, respectively] and cyclosporine [n = 25 (18.7%), 62 (50.8%), and 16 (50.0%), respectively]. The region was identified as a significant predictor of use of intravenous methylprednisolone in MCD and MN patients. Conclusion: Use of intravenous methylprednisolone for MCD and MN differed geographically in Japan. Its efficacy should be further evaluated in a well-designed trial.

Original languageEnglish
Pages (from-to)1-15
Number of pages15
JournalClinical and Experimental Nephrology
DOIs
Publication statusAccepted/In press - Apr 20 2018

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Nephrotic Syndrome
Immunosuppressive Agents
Lipoid Nephrosis
Japan
Cohort Studies
Membranous Glomerulonephritis
Focal Segmental Glomerulosclerosis
Registries
Methylprednisolone
Kidney
Biopsy
Therapeutics
Logistic Models
Pharmaceutical Preparations
Cyclosporine
Prospective Studies

Keywords

  • Cyclosporine
  • Focal and segmental glomerulosclerosis
  • Membranous nephropathy
  • Methylprednisolone
  • Minimal change disease

ASJC Scopus subject areas

  • Physiology
  • Nephrology
  • Physiology (medical)

Cite this

Regional variations in immunosuppressive therapy in patients with primary nephrotic syndrome : the Japan nephrotic syndrome cohort study. / Yamamoto, Ryohei; Imai, Enyu; Maruyama, Shoichi; Yokoyama, Hitoshi; 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; Yoshio, Terada; 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; Kashihara, Naoki; Sato, Hiroshi; Matsuo, Seiichi; Narita, Ichiei; Isaka, Yoshitaka.

In: Clinical and Experimental Nephrology, 20.04.2018, p. 1-15.

Research output: Contribution to journalArticle

Yamamoto, R, Imai, E, Maruyama, S, Yokoyama, H, Sugiyama, H, Nitta, K, Tsukamoto, T, Uchida, S, Takeda, A, Sato, T, Wada, T, Hayashi, H, Akai, Y, Fukunaga, M, Tsuruya, K, Masutani, K, Konta, T, Shoji, T, Hiramatsu, T, Goto, S, Tamai, H, Nishio, S, Shirasaki, A, Nagai, K, Yamagata, K, Hasegawa, H, Yasuda, H, Ichida, S, Naruse, T, Fukami, K, Nishino, T, Sobajima, H, Tanaka, S, Akahori, T, Ito, T, Yoshio, T, Katafuchi, R, Fujimoto, S, Okada, H, Ishimura, E, Kazama, JJ, Hiromura, K, Mimura, T, Suzuki, S, Saka, Y, Sofue, T, Suzuki, Y, Shibagaki, Y, Kitagawa, K, Morozumi, K, Fujita, Y, Mizutani, M, Shigematsu, T, Kashihara, N, Sato, H, Matsuo, S, Narita, I & Isaka, Y 2018, 'Regional variations in immunosuppressive therapy in patients with primary nephrotic syndrome: the Japan nephrotic syndrome cohort study', Clinical and Experimental Nephrology, pp. 1-15. https://doi.org/10.1007/s10157-018-1579-x
Yamamoto, Ryohei ; Imai, Enyu ; Maruyama, Shoichi ; Yokoyama, Hitoshi ; 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 ; Yoshio, Terada ; 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 ; Kashihara, Naoki ; Sato, Hiroshi ; Matsuo, Seiichi ; Narita, Ichiei ; Isaka, Yoshitaka. / Regional variations in immunosuppressive therapy in patients with primary nephrotic syndrome : the Japan nephrotic syndrome cohort study. In: Clinical and Experimental Nephrology. 2018 ; pp. 1-15.
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abstract = "Background: The lack of high-quality clinical evidences hindered broad consensus on optimal therapies for primary nephrotic syndromes. The aim of the present study was to compare prevalence of immunosuppressive drug use in patients with primary nephrotic syndrome across 6 regions in Japan. Methods: Between 2009 and 2010, 380 patients with primary nephrotic syndrome in 56 hospitals were enrolled in a prospective cohort study [Japan Nephrotic Syndrome Cohort Study (JNSCS)], including 141, 151, and 38 adult patients with minimal change disease (MCD), membranous nephropathy (MN), and focal segmental glomerulosclerosis (FSGS), respectively. Their clinical characteristics were compared with those of patients registered in a large nationwide registry of kidney biopsies [Japan Renal Biopsy Registry (J-RBR)]. The regional prevalence of use of each immunosuppressive drug was assessed among adult MCD, MN, and FSGS patients who underwent immunosuppressive therapy in the JNSCS (n = 139, 127, and 34, respectively). Predictors of its use were identified using multivariable-adjusted logistic regression models. Results: The clinical characteristics of JNSCS patients were comparable to those of J-RBR patients, suggesting that the JNSCS included the representatives in the J-RBR. The secondary major immunosuppressive drugs were intravenous methylprednisolone [n = 33 (24.6{\%}), 24 (19.7{\%}), and 9 (28.1{\%}) in MCD, MN, and FSGS, respectively] and cyclosporine [n = 25 (18.7{\%}), 62 (50.8{\%}), and 16 (50.0{\%}), respectively]. The region was identified as a significant predictor of use of intravenous methylprednisolone in MCD and MN patients. Conclusion: Use of intravenous methylprednisolone for MCD and MN differed geographically in Japan. Its efficacy should be further evaluated in a well-designed trial.",
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author = "Ryohei Yamamoto and Enyu Imai and Shoichi Maruyama and Hitoshi Yokoyama and Hitoshi Sugiyama and Kosaku Nitta and Tatsuo Tsukamoto and Shunya Uchida and Asami Takeda and Toshinobu Sato and Takashi Wada and Hiroki Hayashi and Yasuhiro Akai and Megumu Fukunaga and Kazuhiko Tsuruya and Kosuke Masutani and Tsuneo Konta and Tatsuya Shoji and Takeyuki Hiramatsu and Shunsuke Goto and Hirofumi Tamai and Saori Nishio and Arimasa Shirasaki and Kojiro Nagai and Kunihiro Yamagata and Hajime Hasegawa and Hidemo Yasuda and Shizunori Ichida and Tomohiko Naruse and Kei Fukami and Tomoya Nishino and Hiroshi Sobajima and Satoshi Tanaka and Toshiyuki Akahori and Takafumi Ito and Terada Yoshio and Ritsuko Katafuchi and Shouichi Fujimoto and Hirokazu Okada and Eiji Ishimura and Kazama, {Junichiro James} and Keiju Hiromura and Tetsushi Mimura and Satashi Suzuki and Yosuke Saka and Tadashi Sofue and Yusuke Suzuki and Yugo Shibagaki and Kiyoki Kitagawa and Kunio Morozumi and Yoshiro Fujita and Makoto Mizutani and Takashi Shigematsu and Naoki Kashihara and Hiroshi Sato and Seiichi Matsuo and Ichiei Narita and Yoshitaka Isaka",
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TY - JOUR

T1 - Regional variations in immunosuppressive therapy in patients with primary nephrotic syndrome

T2 - the Japan nephrotic syndrome cohort study

AU - Yamamoto, Ryohei

AU - Imai, Enyu

AU - Maruyama, Shoichi

AU - Yokoyama, Hitoshi

AU - Sugiyama, Hitoshi

AU - Nitta, Kosaku

AU - Tsukamoto, Tatsuo

AU - Uchida, Shunya

AU - Takeda, Asami

AU - Sato, Toshinobu

AU - Wada, Takashi

AU - Hayashi, Hiroki

AU - Akai, Yasuhiro

AU - Fukunaga, Megumu

AU - Tsuruya, Kazuhiko

AU - Masutani, Kosuke

AU - Konta, Tsuneo

AU - Shoji, Tatsuya

AU - Hiramatsu, Takeyuki

AU - Goto, Shunsuke

AU - Tamai, Hirofumi

AU - Nishio, Saori

AU - Shirasaki, Arimasa

AU - Nagai, Kojiro

AU - Yamagata, Kunihiro

AU - Hasegawa, Hajime

AU - Yasuda, Hidemo

AU - Ichida, Shizunori

AU - Naruse, Tomohiko

AU - Fukami, Kei

AU - Nishino, Tomoya

AU - Sobajima, Hiroshi

AU - Tanaka, Satoshi

AU - Akahori, Toshiyuki

AU - Ito, Takafumi

AU - Yoshio, Terada

AU - Katafuchi, Ritsuko

AU - Fujimoto, Shouichi

AU - Okada, Hirokazu

AU - Ishimura, Eiji

AU - Kazama, Junichiro James

AU - Hiromura, Keiju

AU - Mimura, Tetsushi

AU - Suzuki, Satashi

AU - Saka, Yosuke

AU - Sofue, Tadashi

AU - Suzuki, Yusuke

AU - Shibagaki, Yugo

AU - Kitagawa, Kiyoki

AU - Morozumi, Kunio

AU - Fujita, Yoshiro

AU - Mizutani, Makoto

AU - Shigematsu, Takashi

AU - Kashihara, Naoki

AU - Sato, Hiroshi

AU - Matsuo, Seiichi

AU - Narita, Ichiei

AU - Isaka, Yoshitaka

PY - 2018/4/20

Y1 - 2018/4/20

N2 - Background: The lack of high-quality clinical evidences hindered broad consensus on optimal therapies for primary nephrotic syndromes. The aim of the present study was to compare prevalence of immunosuppressive drug use in patients with primary nephrotic syndrome across 6 regions in Japan. Methods: Between 2009 and 2010, 380 patients with primary nephrotic syndrome in 56 hospitals were enrolled in a prospective cohort study [Japan Nephrotic Syndrome Cohort Study (JNSCS)], including 141, 151, and 38 adult patients with minimal change disease (MCD), membranous nephropathy (MN), and focal segmental glomerulosclerosis (FSGS), respectively. Their clinical characteristics were compared with those of patients registered in a large nationwide registry of kidney biopsies [Japan Renal Biopsy Registry (J-RBR)]. The regional prevalence of use of each immunosuppressive drug was assessed among adult MCD, MN, and FSGS patients who underwent immunosuppressive therapy in the JNSCS (n = 139, 127, and 34, respectively). Predictors of its use were identified using multivariable-adjusted logistic regression models. Results: The clinical characteristics of JNSCS patients were comparable to those of J-RBR patients, suggesting that the JNSCS included the representatives in the J-RBR. The secondary major immunosuppressive drugs were intravenous methylprednisolone [n = 33 (24.6%), 24 (19.7%), and 9 (28.1%) in MCD, MN, and FSGS, respectively] and cyclosporine [n = 25 (18.7%), 62 (50.8%), and 16 (50.0%), respectively]. The region was identified as a significant predictor of use of intravenous methylprednisolone in MCD and MN patients. Conclusion: Use of intravenous methylprednisolone for MCD and MN differed geographically in Japan. Its efficacy should be further evaluated in a well-designed trial.

AB - Background: The lack of high-quality clinical evidences hindered broad consensus on optimal therapies for primary nephrotic syndromes. The aim of the present study was to compare prevalence of immunosuppressive drug use in patients with primary nephrotic syndrome across 6 regions in Japan. Methods: Between 2009 and 2010, 380 patients with primary nephrotic syndrome in 56 hospitals were enrolled in a prospective cohort study [Japan Nephrotic Syndrome Cohort Study (JNSCS)], including 141, 151, and 38 adult patients with minimal change disease (MCD), membranous nephropathy (MN), and focal segmental glomerulosclerosis (FSGS), respectively. Their clinical characteristics were compared with those of patients registered in a large nationwide registry of kidney biopsies [Japan Renal Biopsy Registry (J-RBR)]. The regional prevalence of use of each immunosuppressive drug was assessed among adult MCD, MN, and FSGS patients who underwent immunosuppressive therapy in the JNSCS (n = 139, 127, and 34, respectively). Predictors of its use were identified using multivariable-adjusted logistic regression models. Results: The clinical characteristics of JNSCS patients were comparable to those of J-RBR patients, suggesting that the JNSCS included the representatives in the J-RBR. The secondary major immunosuppressive drugs were intravenous methylprednisolone [n = 33 (24.6%), 24 (19.7%), and 9 (28.1%) in MCD, MN, and FSGS, respectively] and cyclosporine [n = 25 (18.7%), 62 (50.8%), and 16 (50.0%), respectively]. The region was identified as a significant predictor of use of intravenous methylprednisolone in MCD and MN patients. Conclusion: Use of intravenous methylprednisolone for MCD and MN differed geographically in Japan. Its efficacy should be further evaluated in a well-designed trial.

KW - Cyclosporine

KW - Focal and segmental glomerulosclerosis

KW - Membranous nephropathy

KW - Methylprednisolone

KW - Minimal change disease

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JO - Clinical and Experimental Nephrology

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SN - 1342-1751

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