Abstract: TH-PO997
The Incidence and Timing of Infectious Complications Relating to Immunosuppressive Treatment Among Adult Japanese Minimal Change Disease and Focal Segmental Glomerulosclerosis: A Retrospective Study
Session Information
- Glomerular Diseases: Minimal Change Disease, FSGS, IgAN
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Ozeki, Takaya, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Kato, Sawako, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Yasuda, Yoshinari, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Maruyama, Shoichi, Nagoya University Graduate School of Medicine, Nagoya, Japan
Background
Among adult minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS), some patients require high-intensity or long-term immunosuppressive therapy because of poor treatment response or relapses. However, there are few reports investigating the incidence of infectious complications and its timing during immunosuppressive therapies.
Methods
Multicenter retrospective cohort study. MCD/FSGS diagnosed by kidney biopsy from 2005 to 2015 at Nagoya university and 15 affiliated hospitals were included. Age<20, non-nephrotic cases, secondary cases, patients who did not receive any immunosuppressive treatment or patients who dropped-out within 4 weeks were excluded from the analyses. The incidence and its timing of infections that were treated under hospitalization were evaluated using Kaplan-Meier method.
Results
Among 298 cases (MCD/FSGS: 243/55 cases), 270 (89.9%, MCD/FSGS: 95.1/67.3%) attained complete remission (CR). The median values of duration for CR were 14 days in MCD and 38 days in FSGS (p=0.05). Thirty-nine (13.1%) patients suffered from infections at least once during entire observation and pneumonia was the most common (11 cases). Twenty-two out of 39 (56.4%) cases had infections within 6 months from the initiation of immunosuppressive treatment. In Kaplan-Meier analysis, the risk for infections were higher in FSGS patients (p=0.034 vs. MCD) or elderly patients (age≥65, p<0.001 vs. age<64). When patients were categorized into 4 subgroups according to the duration for CR (patients who attained CR within 4 weeks, 4-8 weeks, 8-16 weeks and over 16 weeks), poor-responders (CR over 16 weeks) demonstrated the highest risk and early-responders (CR within 4 weeks) showed the lowest risk for infections (p>0.001 in log-rank test). Multivariate Cox proportional hazard model showed that elderly patients (adjusted HR: 3.35, 95% CI: 1.61-6.97, p<0.001), baseline eGFR (adjusted HR: 0.83 for every 10 mL/min/1.73m2, 95% CI: 0.63-0.99, p=0.038) and poor-responders (adjusted HR: 4.80, 95% CI: 1.86-12.35, p=0.001) were associated to infections.
Conclusion
Among patients with adult MCD/FSGS, infections relating to immunosuppressive therapies should be taken in mind especially in poor-responders as well as elderly.
Funding
- Commercial Support –