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Kidney Week

Abstract: TH-PO992

Study on Association of Initial Prednisolone Dose with Remission, Relapse, and Infectious Complication in Adult-Onset Minimal Change Disease

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Tanabe, Kaori, Nara Medical University, Nara-ken, Japan
  • Samejima, Ken-ichi, Nara Medical University, Nara-ken, Japan
  • Tsushima, Hideo, Nara Medical University, Nara-ken, Japan
  • Morimoto, Katsuhiko, Nara Prefecture Western Medical Center, Ikoma-gun, Nara, Japan
  • Matsui, Masaru, Nara Prefecture General Medical Center, Nara, NARA, Japan
  • Tagawa, Miho, Nara Medical University, Nara-ken, Japan
  • Eriguchi, Masahiro, Nara Medical University, Nara-ken, Japan
  • Akai, Yasuhiro, Nara Medical University, Nara-ken, Japan
  • Tsuruya, Kazuhiko, Nara Medical University, Nara-ken, Japan
Background

Majority of patients with minimal change disease (MCD) are steroid sensitive with good renal prognosis. However, about half of the cases relapses during prednisolone (PSL) tapering after remission of nephrotic syndrome. The initial dose of PSL varies by reports from 0.5 to 1 mg/kg/day. But little is known about the optimal PSL dose for initial treatment of MCD.

Methods

This is a retrospective multicenter cohort study on treatment-naïve adult patients with MCD diagnosed by renal biopsy from 1981 to 2015. The exposure of interest was initial dose of PSL <0.683 mg/kg/day (median) (Group L) compared to ≥0.683 mg/kg/day (Group H). Cumulative remission and relapse after remission were compared using Cox regression adjusted with for baseline characteristics. Median time to remission, 4-week remission rate, and incidence of infection that requires hospitalization during the 6 months following steroid therapy were also compared using Mann-Whitney U test and Chi-square test.

Results

Among 70 patients who met the criterion, 38 (54.3%) were male and the average age was 46.8 ± 20.1 years. During a median follow-up of 3.2 years, 67 (95.7%) achieved complete remission and 35 (52.2%) relapsed after remission. The median initial dose of PSL was 0.63 and 0.73 mg/kg/day in Group L and H, respectively. There was no significant difference in remission rate between Group L and H at 4 weeks (74.3 vs 71.4%; p=0.79). The median time to remission in Group L was comparable to that in Group H (15 vs 14 days; p=0.66). Multivariable Cox hazard model revealed that initial dose of PSL was not a significant predictor for remission (HR 1.23, 95%CI 0.67 to 2.26, p=0.51), but Group L had a trend toward higher relapse rate (HR 2.18, 95%CI 0.94 to 5.25, p=0.07). There was no significant difference in 6-month incidence of infectious complication between the groups (Group L, 5.7% and Group H, 2.9%, p=0.56).

Conclusion

The initial dose of PSL was not associated with time to remission and remission rate, but lower initial dose of PSL had a trend toward higher relapse rate. The results in this study suggest that the dose of PSL would be tapered carefully after remission, when initiating treatment with lower dose of PSL.