Grams ME, Sang Y, Ballew SH, et al, for the Chronic Kidney Disease Prognosis Consortium. Predicting timing of clinical outcomes in patients with chronic kidney disease and severely decreased glomerular filtration rate. Kidney Int. 2018;93:1442–1451

doi:10.1016/j.kint.2018.08.009

Authors

Remy, Philippe; Audard, Vincent; Natella, Pierre André; Pelle, Gaëlle; Dussol, Bertrand; Leray-Moragues, Hélène; Bouachi, Khedidja; Dantal, Jacques; Vrigneaud, Laurence; Karras, Alexandre; Pourcine, Frank; Gatault, Philippe; Grimbert, Philippe; Ait Sahlia, Nawelle; Moktefi, Anissa; Daugas, Eric; Rigothier, Claire; Bastuji-Garin, Sylvie; Sahali, Dil; Aldigier, Jean Claude; Bataille, Pierre; Canaud, Bernard; Chauveau, Dominique; Combe, Christian; Choukroun, Gabriel; Cornec-Legall, Emilie; Dahan, Karine; Delahousse, Michel; Desvaux, Dominique; Deteix, Patrice; Durrbach, Antoine; Esnault, Vincent; Essig, Marie; Fievet, Patrick; Frouget, Thierry; Guerrot, Dominique; Godin, Michel; Gontiers-Picard, Annie; Gosselin, Morgane; Hanrotel-Saliou, Catherine; Heng, Anne-Elisabeth; Huart, Antoine; Humbert, Antoine; Kofman, Tomek; Hummel, Aurélie; Lang, Philippe; Laville, Maurice; Lemeur, Yannick; Malvezzi, Paolo; Matignon, Marie; Mesbah, Rafik; Moulin, Bruno; Muller, Sandrine; Olagne, Jerome; Pardon, Agathe; Provôt, François; Queffeulou, Guillaume; Plaisier, Emmanuelle; Raimbourg, Quentin; Rieu, Philippe; Stehlé, Thomas; Vanhille, Philippe; Astor, Brad; Levin, Adeera; Tang, Mila; Djurdjev, Ognjenka; Navaneethan, Sankar; Jolly, Stacey; Schold, Jesse; Nally, Joseph; Emberson, Jonathan; Townend, John; Landray, Martin; Feldman, Harold; Hsu, Chi-Yuan; Lash, James; Appel, Lawrence; Kalra, Philip; Ritchie, James; Maharajan, Raman; Middleton, Rachel; O’donoghue, Donal; Schneider, Markus; Kronenberg, Florian; Bärthlein, Barbara; Green, Jamie; Kirchner, H. Lester; Ho, Kevin; Marks, Angharad; Black, Corri; Prescott, Gordon; Fluck, Nick; Nakayama, Masaaki; Miyazaki, Mariko; Yamamoto, Tae; Yamada, Gen; Wang, Angela Yee-Moon; Cheung, Sharon; Wong, Sharon; Chu, Jessie; Wu, Henry; Garg, Amit; Mcarthur, Eric; Nash, Danielle; Shalev, Varda; Chodick, Gabriel; Blankestijn, Peter, J; Wetzels, Jack F.M.; van Zuilen, Arjan; van den Brand, Jan, a J G; Inker, Lesley; Sarnak, Mark; Tighiouart, Hocine; Zhang, Haitao; Stengel, Bénédicte; Metzger, Marie; Flamant, Martin; Houillier, Pascal; Haymann, Jean-Philippe; Rios, Pablo; Mazzuchi, Nelson; Gadola, Liliana; Lamadrid, Verónica; Solá, Laura; Collins, John; Elley, C. Raina; Kenealy, Timothy; Moranne, Olivier; Couchoud, Cécile; Vigneau, Cécile; Brunskill, Nigel; Major, Rupert; Shepherd, David; Medcalf, James; Kovesdy, Csaba; Kalantar-Zadeh, Kamyar; Sumida, Keiichi; Potukuchi, Praveen; Heerspink, Hiddo J.L.; de Zeeuw, Dick; Brenner, Barry; Carrero, Juan Jesus; Gasparini, Alessandro; Qureshi, Abdul Rashid; Elinder, Carl-Gustaf; Visseren, Frank L.J.; van Der Graaf, Yolanda; Evans, Marie; Stendahl, Maria; Schön, Staffan; Segelmark, Mårten; Prütz, Karl-Göran; Naimark, David; Tangri, Navdeep; Mark, Patrick; Traynor, Jamie; Geddes, Colin; Thomson, Peter; Chang, Alex; Gansevoort, Ron, T; Köttgen, Anna; Levey, Andrew; Zhang, Luxia; Ballew, Shoshana; Chen, Jingsha; Coresh, Josef; Grams, Morgan; Kwak, Lucia; Matsushita, Kunihiro; Sang, Yingying; Surapaneni, Aditya; Woodward, Mark; Eckardt, Kai-Uwe; Hemmelgarn, Brenda; Wheeler, David; Winkelmayer, Wolfgang; Davis, John; Green, Danielle; Cheung, Michael; Green, Tanya; Mcmahan, Melissa; Molnar, Miklos, Z. + 177

Contributors

Service de néphrologie CHU Henri Mondor; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Henri Mondor Créteil; Assistance Publique-Hôpitaux de Paris, Department of Pathology, Centre hospitalier universitaire Henri Mondor, F-94000 Créteil, France; Department of Nephrology and Transplantation, Foch Hospital,; Department of Nephrology and Transplantation, Foch Hospital; Chirurgie urologique et transplantation rénale Hôpital de la Conception - APHM; Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception CHU - APHM (LA CONCEPTION); Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN); Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE); Centre Hospitalier Régional Universitaire Montpellier (CHRU Montpellier); Service de néphrologie et transplantation; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12); Institut Transplantation Urologie et Néphrologie; Centre Hospitalier Universitaire de Nantes (CHU Nantes); Centre hospitalier Valenciennes, Nord; Hôpital Européen Georges Pompidou APHP (HEGP); Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO); Service de Néphrologie CHU TOURS; INSERM U955, équipe 21; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut Mondor de Recherche Biomédicale (IMRB); Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12); UMR 1599; Centre National de la Recherche Scientifique (CNRS); Department of Nephrology, Transplantation and Dialysis, Bordeaux; Laboratoire d'Investigation Clinique (LIC); Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12); Hôpital Henri Mondor; Université de Lausanne = University of Lausanne (UNIL); Service Médecine interne et immunopathologie clinique CHU Toulouse; Pôle IUCT CHU Toulouse; Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse); CHU Bordeaux; Unité Médicale de Soins Intensifs; CHU Amiens-Picardie; CHRU Brest - Service de Nephrologie (CHU - BREST - Nephrologie); Centre Hospitalier Régional Universitaire de Brest (CHRU Brest); CHU Tenon AP-HP; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU); Service de transplantation rénale; Hôpital Foch Suresnes; Institut Mondor de Recherche Biomédicale (IMRB); Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12); Service Néphrologie, Pôle REUNNIRH; CHU Clermont-Ferrand; U542; Institut National de la Santé et de la Recherche Médicale (INSERM); Service de néphrologie; Centre Hospitalier Universitaire de Nice (CHU Nice); Service de Néphrologie, Dialyse, Transplantations CHU Limoges; CHU Limoges; Univers, Transport, Interfaces, Nanostructures, Atmosphère et environnement, Molécules (UMR 6213) (UTINAM); Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC); Université Bourgogne Franche-Comté COMUE (UBFC)-Université Bourgogne Franche-Comté COMUE (UBFC); Centre Hospitalier Universitaire de Rennes CHU Rennes = Rennes University Hospital Ponchaillou; Service de Néphrologie Rouen; CHU Rouen; Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN); Normandie Université (NU); Nouvelles Cibles Pharmacologiques de la Protection Endothéliale et de l'Insuffisance Cardiaque (EnVI); Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM); Service de Néphrologie; Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Hôpital de la Cavale Blanche - CHRU Brest (CHU - BREST ); Unité de Nutrition Humaine (UNH); Institut National de la Recherche Agronomique (INRA)-Université Clermont Auvergne 2017-2020 (UCA 2017-2020 ); Hôpital Necker - Enfants Malades AP-HP; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP); Centre Hospitalier Lyon Sud CHU - HCL (CHLS); Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL); Service de néphrologie, dialyse, aphérèses et transplantation; Centre Hospitalier Universitaire CHU Grenoble (CHUGA)-Université Grenoble Alpes 2016-2019 (UGA 2016-2019 ); CH Boulogne sur Mer; Service de Néphrologie et Transplantation; Centre Hospitalier Universitaire Strasbourg (CHU Strasbourg); Les Hôpitaux Universitaires de Strasbourg (HUS)-Les Hôpitaux Universitaires de Strasbourg (HUS); CHU Saint-Antoine AP-HP; Service de Néphrologie CHPC - Site Louis Pasteur; Site Louis Pasteur CHPC; CH Centre Hospitalier Public du Cotentin (CHPC)-CH Centre Hospitalier Public du Cotentin (CHPC); Remodelage et Reparation du Tissu Renal (UMR S702); Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM); Service de Néphrologie Bichat - Claude Bernard; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard Paris; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7); Hôpital universitaire Robert Debré Reims; Université Paris Descartes - Faculté de Médecine (UPD5 Médecine); Université Paris Descartes - Paris 5 (UPD5); Service de médecine interne et néphrologie; Division of Nephrology Vancouver, BC, Canada; University of British Columbia (UBC); Aberdeen University; Fraunhofer Institute for Secure Information Technology Darmstadt (Fraunhofer SIT); Fraunhofer (Fraunhofer-Gesellschaft) + 91

Publisher

HAL CCSD; Nature Publishing Group

Abstract

International audience ; First-line therapy of minimal change nephrotic syndrome (MCNS) in adults is extrapolated largely from pediatric studies and consists of high-dose oral corticosteroids. We assessed whether a low corticosteroid dose combined with mycophenolate sodium was superior to a standard oral corticosteroid regimen. We enrolled 116 adults with MCNS in an open-label randomized controlled trial involving 32 French centers. Participants randomly assigned to the test group (n=58) received low-dose prednisone (0.5 mg/kg/day, maximum 40 mg/day) plus enteric-coated mycophenolate sodium 720 mg twice daily for 24 weeks; those who did not achieve complete remission after week 8 were eligible for a second-line regimen (increase in the prednisone dose to 1 mg/kg/day with or without Cyclosporine). Participants randomly assigned to the control group (n=58) received conventional high-dose prednisone (1 mg/kg/day, maximum 80 mg/day) for 24 weeks. The primary endpoint of complete remission after four weeks of treatment was ascertained in 109 participants, with no significant difference between the test and control groups. Secondary outcomes, including remission after 8 and 24 weeks of treatment, did not differ between the two groups. During 52 weeks of follow-up, MCNS relapsed in 15 participants (23.1%) who had achieved the primary outcome. Median time to relapse was similar in the test and control groups (7.1 and 5.1 months, respectively), as was the incidence of serious adverse events. Five participants died from hemorrhage (n=2) or septic shock (n=3), including 2 participants in the test group and 3 in the control group. Thus, in adult patients, treatment with low-dose prednisone plus enteric-coated mycophenolate sodium was not superior to a standard high-dose prednisone regimen to induce complete remission of MCNS.

Grams ME, Sang Y, Ballew SH, et al, for the Chronic Kidney Disease Prognosis Consortium. Predicting timing of clinical outcomes in patients with chronic kidney disease and severely decreased glomerula...Read more

Abstract

Grams ME, Sang Y, Ballew SH, et al, for the Chronic Kidney Disease Prognosis Consortium. Predicting timing of clinical outcomes in patients with chronic kidney disease and severely decreased glomerula...