Initiation of renin-angiotensin system inhibitors and first complete remission in patients with primary nephrotic syndrome: a nationwide cohort study.

Sayaka Shimizu,Ichiei Narita,Kosaku Nitta,Tatsuo Tsukamoto,Kakuya Niihata,Ryohei Yamamoto,Asami Takeda,Noriaki Kurita,Hirokazu Okada,Yoshitaka Isaka,Hiroki Nishiwaki,Shunya Uchida,Yugo Shibagaki,Mitsuhiro Sato ,Haruhiko Yoshida ,Masaru Matsui ,Tetsuya Mitarai ,Kouji Tomori ,Terumasa Hayashi ,Makoto Mizutani ,Kazuobu Ichikawa ,Koichi Asahi ,Tadashi Uramatsu ,Tsutomu Sakurada ,Kei Fukami ,Takashi Wada ,Noritoshi Kato ,Satoshi Sanada ,Hideaki Ishikawa ,Yoshio Kushida ,Takuji Ishimoto ,Kazuhiko Tsuruya ,Kosuke Inoue ,Teruo Hidaka ,Enyu Imai ,Takashi Sügimura ,Tatsuya Sasaki ,Aki Hamauchi ,Yukio Yuzawa ,Akemi Ino ,Toru Sakairi ,Hibiki Shinjo ,Taiga Hara ,Toshiki Kimura ,Yoshio Terada ,Naohumi Imai ,Ritsuko Katafuchi ,Hiroshi Sano ,Mina Kato ,Hideaki Nakajima ,Yoriaki Kaneko ,Akinobu Ochi ,Tadashi Sofue ,Ryuzo Nishizono ,Yuka Kurokawa ,Kazuyuki Mise ,Tsuyoshi Watanabe ,Hiroshi Nagae ,Hiromichi Suzuki ,Taro Horino ,Yuta Matsukuma ,Rhohei Kaseda ,Masao Fukunaga ,Hajime Hasegawa ,Keiju Hiromura ,Midori Hasegawa ,Hirofumi Tamai ,Satashi Suzuki ,Shouichi Fujimoto ,Shōji Tanaka ,Hidemo Yasuda ,Tetsuo Minamino ,Kaori Narumi ,Yutaka Fujita ,Shinichi Nishi ,Toshiyuki Akahori ,S Nishio ,Yumi Ito ,Hirotsugu Iwatani ,Kosuke Masutani ,Eri Muso ,Chika Kondo ,Toshio Yamanari ,Yasunori Iwata ,Miho Shimizu ,Taro Yamamoto ,Yasuhiro Abe ,Yoshiro Fujita ,Yuichi Shirasawa ,Takeyuki Hiramatsu ,Masashi Kitagawa ,Masaki Ohya ,Hitoshi Sugiyama ,S Yamada ,Takatsugu Iwashita ,Makoto Yamaguchi ,Hideo Tsushima ,Rho Sato ,Shin Goto ,Tomo Suzuki ,Kiyohito Kawashima ,Isao Osawa ,Akihiro Tsuda ,Daigo Nakazawa ,Kunio Morozumi ,Yoshinori Taniguchi ,Hitoshi Yokoyama ,Yosuke Saka ,Masayo Sato ,Eiji Ishimura ,Hidekazu Ikeuchi ,Yoko Nishijima ,Kazuo Takahashi ,Waichi Sato ,Tomoko Namba ,Hitoshi Homma ,Nichito Nagura ,Yusuke Suzuki ,Toru Mima ,Takahito Moriyama ,Michiko Yamazaki ,Keiko Tanaka ,Kazuto Abe ,Yoshifuru Tamura ,Masao Nakasatomi ,Hideaki Shimizu ,Shoichi Maruyama ,Yoshihiko Watanabe ,Sohachi Fujimoto ,Rieko Morita ,Hajime Nagasu ,Hiroki Hayashi ,Naoki Kashihara ,Junko Yano ,Toshio Doi ,Takahiro Morohiro ,Shunsuke Goto ,Norihiko Sakai ,Takafumi Ito ,Hiroko Kobayashi ,Masao Kikuchi ,Mitsuru Ichii ,Yoko Obata ,Tatsuki Matsumoto ,Tomoya Nishino ,Takatoshi Morinaga ,Akihito Tanaka ,Hiroshi Nagaya ,Yoshiteru Ohno ,Tokiko Endo ,Arimasa Shirasaki ,Mariko Miyazaki ,Takashi Nakamichi ,Nao Nakamura ,Kaori Tanabe ,Shumei Matsueda ,Naotake Tsuboi ,Yasunobu Ishikawa ,Hideyasu Kiyomoto ,Noriko Mori ,Akito Maeshima ,Takayuki Kuriyama ,Kengo Furuichi ,Chika Yoshida ,Tatsuhito Tomino ,Shinya Nakatani ,Norifumi Hayashi ,Yoshihide Fujigaki ,Junichiro James Kazama ,Shunsuke Furuta ,Tetsuhiko Yasuno ,Keiji Fujimoto ,Daisuke Ichikawa ,Norimi Ohashi ,Yasuhiro Ohtsuka ,Yuji Sato ,Kaori Takayanagi ,Miho Tagawa ,So Oshitani ,Tomoki Kosugi ,Tasuku Nakagaki ,Sayuri Shirai ,Hiroshi Sato ,Daijo Inaguma ,Ken‐Ichi Samejima ,Yuki Kusano ,Shinji Kitajima ,Tomohiko Naruse ,Shigeru Shibata ,Koichi Kanozawa ,Akihiro Tsuchimoto ,Taisuke Shimizu ,Shigehisa Koide ,Mikako Hisamichi ,Akifumi Onishi ,Yuichiro Takeda ,Takashi Iwakiri ,Kumiko Moriwaki ,Tadashi Toyama ,Satoshi Tanaka ,Kenji Ito ,Yoshikatsu Kaneko ,Yasuyuki Nagasawa ,Ikue Kobayashi ,Kimio Watanabe ,Toshinobu Sato ,Naoki Haruyama ,Shigeo Negi ,Hiroyuki Suzuki ,Kiyoki Kitagawa ,Yasuhiro Akai ,Kaoru Yasuda ,Yuto Shimamura ,Tomonari Ogawa ,Kojiro Nagai ,Tetsushi Mimura ,Akira Hishida ,Gen Yamada ,Tsutomu Inoue ,Tsuneo Konta ,Hiroyuki Komatsu

doi:10.1007/s10157-023-02331-3

Abstract

Evidence on renin-angiotensin system inhibitors (RASis) effect in reducing urinary protein levels in patients with nephrotic syndrome is insufficient. We determined whether RASis can induce complete remission (CR) in patients on immunosuppressive therapy. This cohort study included 84 adults (median age, 65years; males, 57%) with primary nephrotic syndrome (excluding minimal change disease) not receiving RASis during enrollment in the Japanese Nephrotic Syndrome Cohort Study from January 2009 to December 2010, and were followed up for 5years. Exposure and outcome were RASi initiation and first CR, respectively. Marginal structural models and Poisson regression were used to account for time-varying covariates and estimate causal effects of RASis on CR. Overall, 51 (61%), 73 (87%), and 55 (66%) patients had membranous nephropathy, were prescribed immunosuppressive agents at baseline (1-month post-renal biopsy and/or at start of immunosuppressive therapy), and were prescribed RASis during the study period, respectively. Sixty-five patients experienced firstCR (incidence rate, 5.05/100 person-months). RASi use was associated with a higher (adjusted incidence rate ratio [aIRR] 2.27, 95% confidence interval [CI] 1.06-4.84), and lower (aIRR: 0.17, 95% CI 0.04-0.68) firstCR in patients with membranous nephropathy and other pathologies, respectively. RASis are beneficial as adjuvant therapy for inducing remission in patients with membranous nephropathy.

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