title: 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.
  
  
  METHODS
  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.affiliation: Division of Nephrology and Dialysis, Kitano Hospital, Tazuke Kofukai Medical Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan. muso@kitano-hp.or.jp.
authors.forename: Eri
authors.initials: E
authors.lastname: Muso
authors.affiliation: Ryoshukai Takaishi Fujii Hospital, Takaishi, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Mune
authors.affiliation: Department of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Hirano
authors.affiliation: Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Motoshi
authors.initials: M
authors.lastname: Hattori
authors.affiliation: Department of Nephrology and Hypertension, Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, Fukushima, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Division of Nephrology, Kanazawa Medical University School of Medicine, Uchinada, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yokoyama
authors.affiliation: Department of Clinical Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sato
authors.affiliation: Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Shunya
authors.initials: S
authors.lastname: Uchida
authors.affiliation: Department of Laboratory Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Wada
authors.affiliation: Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Shoji
authors.affiliation: Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Yuzawa
authors.affiliation: Department of Pediatrics, Kinki University School of Medicine, Osaka-Sayama, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Takemura
authors.affiliation: Division of Nephrology, Kanayama Clinic, Nagoya, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Sugiyama
authors.affiliation: Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Nishizawa
authors.affiliation: Division of Nephrology and Rheumatology, Department of Internal Medicine, Fukuoka University, Fukuoka, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Ogahara
authors.affiliation: Department of Advanced Nephrology, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Yorioka
authors.affiliation: The Kidney Foundation, Japan, Tokyo, Japan.
authors.forename: Soichi
authors.initials: S
authors.lastname: Sakai
authors.affiliation: The Kidney Foundation, Japan, Tokyo, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Ogura
authors.affiliation: Wakayama KD Clinic, Wakayama, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Yukawa
authors.affiliation: Department of Nephrology, Nippon Medical School, Tokyo, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Iino
authors.affiliation: Nakayamadera Imai Clinic, Takarazuka, Japan.
authors.forename: Enyu
authors.initials: E
authors.lastname: Imai
authors.affiliation: Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Matsuo
authors.affiliation: Faculty of Medicine, General Medical Research Center, Fukuoka University, Fukuoka, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Saito
mesh_terms: D000328:Adult; D000368:Aged; D001781:Blood Component Removal; D004351:Drug Resistance; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000209:etiology / Q000628:therapy*; D007019:Hypoproteinemia / Q000209:etiology / Q000628:therapy; D008077:Lipoproteins, LDL; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000150:complications / Q000188:drug therapy / Q000628:therapy* / Q000652:urine; D011446:Prospective Studies; D011507:Proteinuria / Q000209:etiology / Q000628:therapy; D012709:Serum Albumin / Q000378:metabolism; D013997:Time Factors
chemical_list: D008077:Lipoproteins, LDL; D012709:Serum Albumin
keywords: Drug-resistant nephrotic syndrome; LDL apheresis; Lipid nephrotoxicity; Short-term results