BMC Nephrology (Oct 2024)

Observational study of immunosuppressive treatment patterns and outcomes in primary membranous nephropathy: a multicenter retrospective analysis

  • Ayşe Serra Artan,
  • Şafak Mirioğlu,
  • Rabia Hacer Hocaoğlu,
  • Kenan Turgutalp,
  • Saide Elif Güllülü Boz,
  • Necmi Eren,
  • Mevlüt Tamer Dinçer,
  • Sami Uzun,
  • Gülizar Şahin,
  • Sim Kutlay,
  • Şimal Köksal Cevher,
  • Hamad Dheir,
  • Mürvet Yılmaz,
  • Taner Baştürk,
  • Erhan Tatar,
  • İlhan Kurultak,
  • Ramazan Öztürk,
  • Hakkı Arıkan,
  • Serap Yadigar,
  • Onur Tunca,
  • Kültigin Türkmen,
  • Ömer Celal Elçioğlu,
  • Bülent Kaya,
  • Şebnem Karakan,
  • Yavuz Ayar,
  • Cuma Bülent Gül,
  • Halil Yazıcı,
  • Savaş Öztürk

DOI
https://doi.org/10.1186/s12882-024-03784-8
Journal volume & issue
Vol. 25, no. 1
pp. 1 – 10

Abstract

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Abstract Background We evaluated the efficacy of different immunosuppressive regimens in patients with primary membranous nephropathy in a large national cohort. Methods In this registry study, 558 patients from 47 centers who were treated with at least one immunosuppressive agent and had adequate follow-up data were included. Primary outcome was defined as complete (CR) or partial remission (PR). Secondary composite outcome was at least a 50% reduction in estimated glomerular filtration (eGFR), initiation of kidney replacement therapies, development of stage 5 chronic kidney disease, or death. Results Median age at diagnosis was 48 (IQR: 37–57) years, and 358 (64.2%) were male. Patients were followed for a median of 24 (IQR: 12–60) months. Calcineurin inhibitors (CNIs) with or without glucocorticoids were the most commonly used regimen (43.4%), followed by glucocorticoids and cyclophosphamide (GC-CYC) (39.6%), glucocorticoid monotherapy (25.8%), and rituximab (RTX) (9.1%). Overall remission rate was 66.1% (CR 26.7%, PR 39.4%), and 59 (10.6%) patients reached secondary composite outcome. Multivariate logistic regression showed that baseline eGFR (OR 1.011, 95% CI: 1.003–1.019, p = 0.007), serum albumin (OR 1.682, 95% CI: 1.269–2.231, p < 0.001), and use of RTX (OR 0.296, 95% CI: 0.157–0.557, p < 0.001) were associated with remission rates; whereas only lower baseline hemoglobin was significantly associated with secondary composite outcome (OR: 0.843, 95% CI: 0.715–0.993, p = 0.041). CYC use was significantly associated with higher remission (OR 1.534, 95% CI: 1.027–2.290, p = 0.036). Conclusions Higher baseline eGFR and serum albumin levels correlated with increased remission rates. Remission rates were lower in patients treated with RTX, while those on GC-CYC showed higher rates of remission. Due to the study’s retrospective nature and multiple treatments used, caution is warranted in interpreting these findings.

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