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ニッタ コウサク
NITTA Kousaku
新田 孝作 所属 医学部 医学科（東京女子医科大学病院） 職種 客員教授 |
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| 論文種別 | 原著 |
| 言語種別 | 英語 |
| 査読の有無 | 査読なし |
| 表題 | Attribute-Based Medicine for IgA Nephropathy: Risk Factor Constellations Influence Kidney Prognosis. |
| 掲載誌名 | 正式名：Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 略 称：Nephrol Dial Transplant ISSNコード：14602385/09310509 |
| 掲載区分 | 国外 |
| 巻・号・頁 | pp.online |
| 著者・共著者 | Hiroshi Kataoka, Shun Manabe, Takahito Moriyama, Yusuke Ushio, Kosaku Nitta, Junichi Hoshino, Keita Hirano, Keiichi Matsuzaki, Takashi Yasuda, Yoshinari Yasuda, Tetsuya Kawamura, Shoichi Maruyama, Takashi Yokoo, Yusuke Suzuki |
| 発行年月 | 2025/08/27 |
| 概要 | BACKGROUND AND HYPOTHESIS:Attribute-based medicine emphasizes tailoring care to patient-specific characteristics. IgA nephropathy (IgAN), a heterogeneous glomerular disease, presents varying risks across subgroups. We hypothesized that an attribute-based medicine approach could identify residual risk factors and inform personalized strategies.METHODS:We analysed data from 996 patients from the Japanese Nationwide Retrospective Cohort Study in IgAN. The primary outcome was kidney replacement therapy initiation or a 1.5-fold increase in serum creatinine. Six pre-specified attributes were assessed: age, sex, body mass index (BMI), chronic kidney disease (CKD) stage, urinary protein excretion (U-Prot), and urine occult blood (U-OB). Cox regression and Kaplan-Meier analyses were performed to evaluate interactions between attributes and risk factors.RESULTS:Poor kidney prognosis was associated with lower estimated glomerular filtration rate (eGFR) (per 10 mL/min/1.73 m² increase, hazard ratio [HR]=0.87), higher U-Prot (log-transformed HR=4.54), and hyperuricaemia (HR=1.64), while oral corticosteroids (HR=0.60) and tonsillectomy (HR=0.44) were protective factors. Significant interactions included the following: hyperuricaemia with BMI<22 kg/m²; hypertension with female sex; eGFR and age with CKD stage; U-Prot with age, eGFR, and corticosteroid use; and U-Prot with U-OB. Prognostic effects of age and eGFR were reversed for CKD stage 3 compared with stages 1-2. U-Prot was the most consistent predictor of poor prognosis, especially in patients with U-OB≤2+. Corticosteroids improved outcomes in patients with U-Prot≥1 g/day, while tonsillectomy was effective in those with U-OB≥3+.CONCLUSION:Attribute-based analysis revealed critical risk modifiers and supported stratified treatment strategies for IgAN. These findings underscore the potential of attribute-based medicine in guiding personalized care for patients with IgAN. |
| DOI | 10.1093/ndt/gfaf170 |
| PMID | 40864144 |