Immediate therapeutic efficacy of low-density lipoprotein apheresis for drug-resistant nephrotic syndrome: evidence from the short-term results from the POLARIS Study.

Abstract

BACKGROUND:

Hyperlipidemia is not merely a complication but a major exacerbating factor in longstanding nephrotic syndrome (NS). Low-density lipoprotein apheresis (LDL-A) has been reported to ameliorate dyslipidemia and induce rapid remission of NS. Several clinical studies have suggested the therapeutic efficacy of LDL-A, but the level of clinical evidence is insufficient. Therefore, a multicenter prospective study, POLARIS (Prospective Observational Survey on the Long-Term Effects of LDL Apheresis on Drug-Resistant Nephrotic Syndrome), was initiated in Japan.

METHOD:

Patients with drug-resistant NS were prospectively recruited into the study and treated with LDL-A in facilities that were registered in advance. In the POLARIS study design, the clinical data are to be followed up for 2 years. In the current study, we aimed at evaluating the short-term efficacy based on the treatment outcome of LDL-A immediately after completion of treatment.

RESULTS:

Along with rapid improvement of hyperlipidemia, LDL-A significantly improved proteinuria and hypoproteinemia after treatment. More than half of the patients showed remission of NS based on the urinary protein level at the completion of LDL-A. The duration of NS before the start of treatment was significantly shorter in patients who responded to LDL-A.

CONCLUSIONS:

An analysis of patients registered in the POLARIS study indicated that LDL-A has short-term efficacy for drug-resistant NS. Rapid relief of dyslipidemia by LDL-A may provide early remission in about half of the NS patients who are resistant to conventional medication. Completion of the POLARIS study may reveal additional long-term effects of LDL-A in these patients.

• Authors: Eri Muso, Masatoshi Mune, Tsutomu Hirano, Motoshi Hattori, Kenjiro Kimura, Tsuyoshi Watanabe, Hitoshi Yokoyama, Hiroshi Sato, Shunya Uchida, Takashi Wada, Tetsuo Shoji, Yukio Yuzawa, Tsukasa Takemura, Satoshi Sugiyama, Yoshiki Nishizawa, Satoru Ogahara, Noriaki Yorioka, Soichi Sakai, Yosuke Ogura, Susumu Yukawa, Yasuhiko Iino, Enyu Imai, Seiichi Matsuo, Takao Saito
• Journal: Clinical and experimental nephrology (Clin Exp Nephrol) Vol. 19 Issue 3 Pg. 379-86 (Jun 2015) ISSN: 1437-7799 [Electronic] Japan
• PMID: 24934117 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)

Chemical References

• Lipoproteins, LDL
• Serum Albumin

Topics

• Adult
• Aged
• Blood Component Removal
• Drug Resistance
• Female
• Humans
• Hyperlipidemias (etiology, therapy)
• Hypoproteinemia (etiology, therapy)
• Lipoproteins, LDL
• Male
• Middle Aged
• Nephrotic Syndrome (complications, drug therapy, therapy, urine)
• Prospective Studies
• Proteinuria (etiology, therapy)
• Serum Albumin (metabolism)
• Time Factors