Therapeutic variability in adult minimal change disease and focal segmental glomerulosclerosis
Fernández-Juárez, Gema (Hospital Universitario Fundación Alcorcón)
Villacorta, Javier (Hospital Universitario Fundación Alcorcón)
Ruiz-Roso, Gloria (Hospital Universitario Ramón y Cajal (Madrid))
Panizo, Nayara (Hospital General Universitario Gregorio Marañón)
Martinez-Marín, Isabel (Hospital Universitario Fundación Alcorcón)
Marco Rusiñol, Helena (Institut d'Investigació Biomèdica Sant Pau)
Arrizabalaga, Pilar (Hospital Clínic i Provincial de Barcelona)
Díaz Encarnación, Montserrat Mercedes (Institut d'Investigació Biomèdica Sant Pau)
Pérez-Gómez, Maria Vanessa (Hospital Universitario Fundación Jiménez Díaz)
Vaca, Marco (Hospital Universitario La Paz (Madrid))
Rodríguez García, Eva (Hospital del Mar (Barcelona, Catalunya))
Cobelo, Carmen (Hospital Universitario Lucus Augusti (Lugo))
Fernandez, Loreto (Hospital Universitario Príncipe de Asturias (Alcalá de Henares, Madrid))
Ávila, Ana (Hospital Universitari Doctor Peset (València))
Praga, Manuel (Hospital Universitario 12 de Octubre (Madrid))
Quereda, Carlos (Hospital Universitario Ramón y Cajal (Madrid))
Ortiz, Alberto (Universidad Autónoma de Madrid)
Universitat Autònoma de Barcelona

Data:	2016
Resum:	Variability in the management of glomerulonephritis may negatively impact efficacy and safety. However, there are little/no data on actual variability in the treatment of minimal change disease (MCD)/focal segmental glomerulosclerosis (FSGS) in adults. We assessed Spanish practice patterns for the management of adult nephrotic syndrome due to MCD or FSGS. The absence of reasonably good evidence on treatment for a disease often increases the variability substantially. Identification of evidence-practice gaps is the first necessary step in the knowledge-to-action cyclical process. We aim to analyse the real clinical practice in adults in hospitals in Spain and compare this with the recently released Kidney Disease: Improving Global Outcomes clinical practice guideline for glomerulonephritis. Participating centres were required to include all adult patients (age >18 years) with a biopsy-proven diagnosis of MCD or FSGS from 2007 to 2011. Exclusion criteria included the diagnosis of secondary nephropathy. We studied 119 Caucasian patients with biopsy-proven MCD (n = 71) or FSGS (n = 48) from 13 Spanish hospitals. Of these patients, 102 received immunosuppressive treatment and 17 conservative treatment. The initial treatment was steroids, except in one patient in which mycophenolate mofetil was used. In all patients, the steroids were given as a single daily dose. The mean duration of steroid treatment at initial high doses was 8. 7 ± 13. 2 weeks and the mean global duration was 38 ± 32 weeks. The duration of initial high-dose steroids was <4 weeks in 41% of patients and >16 weeks in 10. 5% of patients. We did find a weak and negative correlation between the duration of whole steroid treatment in the first episode and the number of the later relapses (r = −0. 24, P = 0. 023). There were 98 relapses and they were more frequent in MCD than in FSGs patients (2. 10 ± 1. 6 versus 1. 56 ± 1. 2; P = 0. 09). The chosen treatment was mainly steroids (95%). Only seven relapses were treated with another drug as a first-line treatment: two relapses were treated with mycophenolate and five relapses were treated with anticalcineurinics. A second-line treatment was needed in 29 patients (24. 4%), and the most frequent drugs were the calcineurin inhibitors (55%), followed by mycophenolate mofetil (31%). Although cyclophosphamide is the recommended treatment, it was used in only 14% of the patients. We found variation from the guidelines in the duration of initial and tapered steroid therapy, in the medical criteria for classifying a steroid-resistant condition and in the chosen treatment for the second-line treatment. All nephrologists started with a daily dose of steroids as the first-line treatment. The most frequently used steroid-sparing drug was calcineurin inhibitors. Cyclophosphamide use was much lower than expected.
Ajuts:	Instituto de Salud Carlos III FIS PI13-00047ISCIII-RETIC Instituto de Salud Carlos III REDinREN RD12-0021
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Clinical practice variability ; Glomerulonephritis ; Immunosuppression
Publicat a:	Clinical Kidney Journal, Vol. 9 (may 2016) , p. 381-386, ISSN 2048-8513

DOI: 10.1093/ckj/sfw028
PMID: 27274821

6 p, 433.6 KB

El registre apareix a les col·leccions:
Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut de Recerca Sant Pau
Articles > Articles de recerca
Articles > Articles publicats