Efficacy and Prognosis of Calcineurin inhibitors and Cyclophosphamide in Treating Idiopathic Membranous Nephropathy in Patients with Type 2 Diabetes

  Objective  The aim of this study was to compare the efficacy and prognosis of different therapeutic regimens in treating idiopathic membranous nephropathy (IMN) in patients with type 2 diabetes.

  Methods  The clinical data were retrospectively collected and analyzed in patients with IMN and type 2 diabetes admitted in the Peking Union Medical College Hospital from January 2004 to April 2015. The patients were classified into three groups and designated as cyclophosphamide (CTX), calcineurin inhibitors (CNIs)and other immunosuppressants groups according to the initial therapeutic regimens. Kaplan-Meier analysis and multivariable Cox regression were used to assess the influence of therapeutic regimens on total remission (TR), complete remission (CR), risks of developing ≥ 30% decline in estimated glomerular filtration rate (eGFR) or end-stage renal disease (ESRD), and risks of achieving fast blood glucose >8 mmol/L.

  Results  Totally, 89 patients meeting the inclusive and exclusive criteria were included in this study. The multivariable Cox analysis showed that patients initially treated with CNIs would be significantly higher to develop ≥ 30% eGFR decline or ESRD (HR=13.505, 95% CI:1.512-120.665, P=0.020) than those treated with CTX. However, the likeliness to reach CR(HR=0.793, 95% CI:0.315-1.999, P=0.623), TR(HR=0.647, 95% CI:0.334-1.252, P=0.196), or fast blood glucose >8 mmol/L (HR=1.709, 95% CI:0.669-4.369, P=0.263) were similar between the two groups.

  Conclusions  In patients with type 2 diabetes, CNIs as the initial treatment for IMN might have comparable remission rate of proteinuria with CTX, but an extra risk of renal function decline. We would better be cautious in choosing the therapeutic regimens to treat IMN in patients with type 2 diabetes.