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
N1 - Funding Information:
Acknowledgements This study was supported in part by a Grant-in-Aid for intractable Renal Diseases Research, Research on rare and intractable diseases, Health and Labour Sciences Research Grants for the Ministry of Health, Labor, and Welfare of Japan. JNSCS has been supported by a large number of investigator in 56 participating facilities (now 55 facilities because of a consolidation of two facilities); Hokkaido University Hospital, Sapporo, Hokkaido (Saori Nishio, Yasunobu Ishikawa, Daigo Nakazawa, and Tasuku Nakagaki); JCHO Sendai Hospital, Sendai, Miyagi (Toshinobu Sato, Mitsuhiro Sato, and Satoru Sanada); Tohoku University Hospital, Sendai, Miyagai (Hiroshi Sato, Mariko Miyazaki, Takashi Nakamichi, Tae Yamamoto, Kaori Narumi, and Gen Yamada); Yamagata University Hospital, Yamagata, Yamagata (Tsuneo Konta, and Kazuobu Ichikawa); Fukushima Medical University Hospital, Fukushima, Fukushima (Junichiro James Kazama, Tsuy-oshi Watanabe, Koichi Asahi, Yuki Kusano, and Kimio Watanabe); University of Tsukuba Hospital, Tsukuba, Ibaraki (Kunihiro Yamagata, Joichi Usui, Shuzo Kaneko, and Tetsuya Kawamura); Gunma University Hospital, Maeashi, Gunma (Keiju Hiromura, Akito Maeshima, Yoriaki Kaneko, Hidekazu Ikeuchi, Toru Sakairi, and Masao Naka-satomi); Saitama Medical Center, Saitama Medical University, Kawa-goe, Saitama (Hajime Hasegawa, Takatsugu Iwashita, Taisuke Shimizu, Koichi Kanozawa, Tomonari Ogawa, Kaori Takayanagi, and Tetsuya Mitarai); Department of Nephrology, Saitama Medical University, Irumagun, Saitama (Hirokazu Okada, Tsutomu Inoue, Hiromichi Suzuki, and Kouji Tomori); Tokyo Women’s Medical University, Shinjuku-ku, Tokyo (Kosaku Nitta, Takahito Moriyama, Akemi Ino, and Masayo Sato); Teikyo University School of Medicine, Itabashi-ku, Tokyo (Shunya Uchida, Hideaki Nakajima, Hitoshi Homma, Nichito Nagura, Yoshifuru Tamura, Shigeru Shibata, and Yoshihide Fujigaki); Juntendo Faculty of Medicine, Bunkyo-ku, Tokyo (Yusuke Suzuki, Yukihiko Takeda, Isao Osawa, and Teruo Hidaka); St. Marianna University, Kawasaki, Kanagawa (Yugo Shibagaki, Sayuri Shirai, Daisuke Ichikawa, Tsutomu Sakurada, Tomo Suzuki, and Mikako Hisamichi); Niigata University Medical and Dental Hospital, Niigata, Niigata (Ichiei Narita, Naohumi Imai, Yumi Ito, Shin Goto, Yoshikatsu Kaneko, and Rhohei Kaseda); Kanazawa Medical University, Uchi-nada, Ishikawa (Hitoshi Yokoyama, Keiji Fujimoto, and Norifumi Hayashi); Kanazawa Univeristy Hospital, Kanazawa, Ishikawa (Takashi Wada, Miho Shimizu, Kengo Furuichi, Norihiko Sakai, Yasunori Iwata, Tadashi Toyama, and Shinji Kitajima); National Hospital Organization Kanazawa Medical Center, Kanazawa, Ishikawa (Kiyoki Kitagawa); Ogaki Municipal Hospital, Ogaki, Gifu (Hiroshi Sobajima, Norimi Ohashi, So Oshitani, and Kiyohito Kawashima); Gifu Prefectural Tajimi Hospital, Tajimi, Gifu (Tetsushi Mimura); Hamamatsu University Hospital, Hamamatsu, Shizuoka (Hidemo Yasuda, Akira Hishida, and Yoshihide Fujigaki); Shizuoka General Hospital, Shizuoka, Shi-zuoka (Satoshi Tanaka, and Noriko Mori); Chutoen General Medical Center, Kakegawa, Shizuoka (Toshiyuki Akahori, and Yutaka Fujita); Nagoya University Graduate School of Medicine, Nagoya, Aichi (Shoichi Maruyama, Naotake Tsuboi, Tomoki Kosugi, Takuji Ishimoto, Takayuki Katsuno, Noritoshi Kato, and Waichi Sato); Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi (Asami Takeda, Kunio Morozumi, Yasuhiro Ohtsuka, Hibiki Shinjo, and Akihito Tanaka); Fujita Health University School of Medicine, Toyoake, Aichi (Hiroki Hayashi, Yukio Yuzawa, Midori Hasegawa, Daijo Inaguma, Shigehisa Koide, and Kazuo Takahashi); Konan Kosei Hospital, Konan, Aichi (Takeyuki Hiramatsu, Shinji Furuta, and Hideaki Ishikawa); Anjo Kosei hospital, Anjo, Aichi (Hirofumi Tamai, and Takatoshi Morinaga); Ichinomiya Municipal Hospital, Ichinomiya, Aichi (Ari-masa Shirasaki, Toshiki Kimura, and Mina Kato); Japanese Red Cross Nagoya Daiichi Hospital, Nagaoya, Aichi (Shizunori Ichida, and Nobuhide Endo); Kasugai Municipal Hospital, Kasugai, Aichi (Tomo-hiko Naruse, Yuzo Watanabe, and Yosuke Saka); Kainan hospital, Yatomi, Aichi (Satashi Suzuki, Michiko Yamazaki, and Rieko Morita); Masuko Memorial Hospital, Nagoya, Aichi (Kunio Morozumi, Kunio Morozumi, Kaoru Yasuda, Chika Kondo, Takahiro Morohiro, Rho Sato, and Yuichi Shirasawa); Chubu Rosai Hospital, Nagoya, Aichi (Yoshiro Fujita, Hideaki Shimizu, and Tatsuhito Tomino); Handa City Hospital, Handa, Aichi (Makoto Mizutani); Yokkaichi Municipal Hospital, Yokkaichi, Mie (Yosuke Saka, Hiroshi Nagaya, and Makoto Yamaguchi); Kitano Hospital, Osaka, Osaka (Tatsuo Tsukamoto, Eri Muso, Hiroyuki Suzuki, Tomomi Endo, and Hiroko Kakita); Toyonaka Municipal Hospital, Toyonaka, Osaka (Megumu Fukunaga); Osaka General Medical Center, Osaka, Osaka (Tatsuya Shoji, and Terumasa Hayashi); Osaka City University Hospital, Osaka, Osaka (Eiji Ishimura, Akihiro Tsuda, Shinya Nakatani, Ikue Kobayashi, Mitsuru Ichii, Akin-obu Ochi, and Yoshiteru Ohno); Osaka Univeristy hospital, Suita, Osaka (Yoshitaka Isaka, Enyu Imai, Yasuyuki Nagasawa, Hirotsugu Iwatani, Ryohei Yamamoto, and Tomoko Namba); Kobe University hospital, Kobe, Hyogo (Shunsuke Goto MD, and Shinichi Nishi); Nara Medical University Hospital, Kashihara, Nara (Yasuhiro Akai, Ken-ichi Samejima, Masaru Matsui, Miho Tagawa, Kaori Tanabe, and Hideo Tsushima); Wakayama Medical University Hospital, Wakayama, Wakayama (Takashi Shigematsu MD, Masaki Ohya, Shigeo Negi, and Toru Mima); Shimane University Hospital, Izumo, Shimane (Takafumi Ito); Okayama Univeristy Hospital, Okayama, Okayama (Hitoshi Sug-iyama, Keiko Tanaka, Toshio Yamanari, Masashi Kitagawa, Akifumi Onishi, and Koki Mise); Kawasaki Medical School, Kurashiki, Okay-ama (Naoki Kashihara, Tamaki Sasaki, Sohachi Fujimoto, and Hajime Nagasu); Graduate School of Medicine, The University of Tokushima,Tokushima,Tokushima (Kojiro Nagai, and Toshio Doi);
Publisher Copyright:
© 2018, Japanese Society of Nephrology.
PY - 2018/12/1
Y1 - 2018/12/1
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
UR - http://www.scopus.com/inward/record.url?scp=85045725562&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85045725562&partnerID=8YFLogxK
U2 - 10.1007/s10157-018-1579-x
DO - 10.1007/s10157-018-1579-x
M3 - Article
C2 - 29679356
AN - SCOPUS:85045725562
SN - 1342-1751
VL - 22
SP - 1266
EP - 1280
JO - Clinical and Experimental Nephrology
JF - Clinical and Experimental Nephrology
IS - 6
ER -