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Kidney Week

Abstract: PO1890

The Epidemiological Comparison Between North American and Japanese FSGS/Minimal Change Disease Patients

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Ozeki, Takaya, University of Michigan, Ann Arbor, United States
  • Larkina, Maria, University of Michigan, Ann Arbor, Michigan, United States
  • Maruyama, Shoichi, Nagoya University Graduate School of Medicine, Nagoya, Japan
  • Kretzler, Matthias, University of Michigan, Ann Arbor, Michigan, United States
  • Mariani, Laura H., University of Michigan, Ann Arbor, Michigan, United States
Background

Few studies directly compared the presentation and treatment response of nephrotic syndrome (NS) considering the racial and ethnic differences of different countries.

Methods

NEPTUNE is a prospective cohort study of NS across 23 North American centers. Nagoya Kidney Disease Registry (N-KDR) is a Japanese retrospective cohort in Nagoya area. Nephrotic FSGS/MCD adults who received immunosuppressive therapy (IST) were included. Demographics and laboratory data of the patents were compared. Time to complete remission (CR: UPCR<0.3) from the start of IST were evaluated using Kaplan-Meier method. The common predictors for CR among both cohorts were evaluated by Cox proportional hazard model and selected using a backward stepwise method.

Results

Eighty-eight NEPTUNE and 302 N-KDR cases were eligible. The median of follow-up was 35 and 47 months in NEPTUNE and N-KDR, respectively. In NEPTUNE, 20.7% were African Americans and 26.1% were Hispanic. NEPTUNE had higher proportion of FSGS (55.7 vs. 16.2%, p<0.001). N-KDR cases were older (55 vs. 43 years, p<0.001) and showed more rapid NS onset (0.8 vs. 1.5 months, p=0.004). NEPTUNE cases demonstrated lower level of UPCR (4.20 vs. 8.00, p<0.001) and hypoalbuminemia (2.6 vs. 1.8 mg/dL, p<0.001). In both cohorts, >85% started on steroid monotherapy. In NEPTUNE, only 1% of patients changed within first 28 days as compared to 10% of N-KDR patients. N-KDR cases showed higher proportion of CR in overall sample (89.7 vs. 62.5%, p<0.001), FSGS (67.4 vs. 42.9%, p=0.015) and MCD (94.1 vs. 87.2%, p=0.113). Multivariate analysis showed associations of FSGS (HR=0.65, 95%CI: 0.52-0.81), hypertension (HR=0.64, 95%CI: 0.45-0.90), serum albumin (HR=0.62, 95%CI: 0.45-0.85) and eGFR (HR=1.24, 95%CI: 1.17-1.32, for 10 mL/min/1.73m2) with time to CR. There were significant interactions between the cohort and hypertension (p=0.008), albumin (p=0.030) and eGFR (p<0.001).

Conclusion

Adult nephrotic FSGS/MCD in the North American cohort showed diverse ethnical background and less severe NS. Japanese patients had a higher rate of response to the IST. FSGS, hypertension, higher albumin, and lower eGFR were considered as shared predictors of poor treatment response between both cohorts.

Funding

  • NIDDK Support