title: A Prospective Observational Survey on the Long-Term Effect of LDL Apheresis on Drug-Resistant Nephrotic Syndrome.
abstract: OBJECTIVE
  LDL apheresis (LDL-A) is used for drug-resistant nephrotic syndrome (NS) as an alternative therapy to induce remission by improvement of hyperlipidemia. Several clinical studies have suggested the efficacy of LDL-A for refractory NS, but the level of evidence remains insufficient. A multicenter prospective study, POLARIS (Prospective Observational Survey on the Long-Term Effects of LDL Apheresis on Drug-Resistant Nephrotic Syndrome), was conducted to evaluate its clinical efficacy with high-level evidence.
  
  
  METHODS
  Patients with NS who showed resistance to primary medication for at least 4 weeks were prospectively recruited to the study and treated with LDL-A. The long-term outcome was evaluated based on the rate of remission of NS 2 years after treatment. Factors affecting the outcome were also examined.
  
  
  RESULTS
  A total of 58 refractory NS patients from 40 facilities were recruited and enrolled as subjects of the POLARIS study. Of the 44 subjects followed for 2 years, 21 (47.7%) showed remission of NS based on a urinary protein (UP) level <1.0 g/day. The UP level immediately after LDL-A and the rates of improvement of UP, serum albumin, serum creatinine, eGFR, and total and LDL cholesterol after the treatment session significantly affected the outcome.
  
  
  CONCLUSIONS
  Almost half of the cases of drug-resistant NS showed remission 2 years after LDL-A. Improvement of nephrotic parameters at termination of the LDL-A treatment was a predictor of a favorable outcome.
authors.affiliation: Division of Nephrology and Dialysis, Kitano Hospital, Tazuke Kofukai Medical Institute, Tokyo, Japan.
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, 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 Medical Science, 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, Tokyo, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Shoji
authors.affiliation: Department of Pediatrics, Kinki University School of Medicine, Osaka, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Takemura
authors.affiliation: Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Yuzawa
authors.affiliation: Division of Nephrology and Rheumatology, Department of Internal Medicine, Fukuoka, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Ogahara
authors.affiliation: Division of Nephrology, Kanayama Clinic, Nagoya, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Sugiyama
authors.affiliation: Department of Nephrology, Nippon Medical School, Tokyo, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Iino
authors.affiliation: Siratori Clinic, Tokyo, Japan.
authors.forename: Soichi
authors.initials: S
authors.lastname: Sakai
authors.affiliation: Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Ogura
authors.affiliation: Kodama Hospital, Wakayama, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Yukawa
authors.affiliation: Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Nishizawa
authors.affiliation: Hiroshima Kidney Organization, Hiroshima, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Yorioka
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: General Medical Research Center, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Saito
keywords: Drug-resistant nephrotic syndrome; LDL apheresis; Long-term outcome; Nephrotic syndrome; POLARIS study; Prospective study; Urinary protein