METHODS: One Hundred thirty biopsy-proven patients with Class III/IV without or with Class V LN were randomized to receive GC (intravenous methylprednisolone for three days then oral prednisolone) with either TAC (target trough level 6 - 8ng/mL) or MMF (1g twice a day) for 96 weeks. Primary endpoint was Sustained Renal Response (SRR) at week 96, defined as proteinuria reduction over 50% and estimated glomerular filtration rate no less than 60mL/min per 1.73m2, and no disease flare or rescue therapies. Secondary endpoints included rates of Complete Renal Remission (CRR) and Partial Renal Remission (PRR) at week 96, SRR at week 48, and adverse events (AE).

RESULTS: TAC and MMF groups (65 patients each) showed no significant difference in the rates of SRR (58.5% vs 69.2% respectively) and CRR (55.4% vs 63.1% respectively) at week 96. SRR rates for TAC and MMF groups were 63.1% vs 66.2% at week 48, respectively. Overall, AE rates did not differ between TAC and MMF groups (80.0% in both). Acute kidney injury and tremors were more frequent in TAC group, while leucopoenia was more frequent in MMF group. Three deaths occurred, all in the MMF group. Treatment-related serious adverse events (SAE) and infection resulting in SAE were significantly more frequent in the MMF group.

CONCLUSIONS: Dual immunosuppressive regimen with TAC and GC showed no difference in efficacy but different safety profile compared with MMF and GC over 96 weeks, when used as continuous induction-maintenance treatment for LN.

METHODS: We analyzed data from the India and Southeast Asia Renal Replacement Therapy (InSEA-RRT) registry, a multicenter cohort study conducted between April 2019 and December 2023 across 24 hospitals in Southeast Asia and India. Critically ill patients with AKI stage 3, as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria, were enrolled. The primary outcome was 2-year MAKE, defined as a composite of persistent kidney dysfunction, long-term dialysis, and all-cause mortality at 2 years post-enrollment.

RESULTS: A total of 2,315 patients were enrolled, of whom 1,033 (47%) died during hospitalization. Among surviving patients, the incidence of 2-year MAKE was 46.6 per 100 person-years (95% CI 42.7-50.6). Notably, mortality (32%) was the dominant component of MAKE. The incidence of new chronic kidney disease (CKD) and CKD progression at 2 years post-AKI was 58.6 and 35.4 per 100 person-year (95% CI 51.0-67.0 and 26.0-47.0), respectively. Multivariable-adjusted models identified older age, male sex, preexisting CKD, malignancy, cardiac-associated AKI, and non-recovery of kidney function after AKI as independent risk factors for 2-year MAKE.