Session Type: Abstract Submissions (ACR)
Renal disease is strongly associated with morbidity and mortality among SLE patients. We utilized the Lupus Clinical Trials Consortium, Inc. longitudinal registry of SLE patients from 16 academic lupus centers to estimate prevalence and incidence of renal disease and associated differences in demographics, comorbidities, biopsy rates, and therapeutic exposures.
Patients were consecutively enrolled and followed at outpatient visits by participating rheumatologists. Lupus nephritis (LN) was defined by ACR Classification Criteria. Damage (end-stage renal disease (ESRD), proteinuria (≥3.5 gm/d), low GFR) was determined by SLICC Damage Index (SDI). Descriptive statistics, chi square, Fisher’s exact, and ANOVA was used as appropriate to compare disease characteristics. Multivariate regression modeling was used to adjust for disease duration and race. P <0.05 was considered statistically significant.
Of 1507 patients, 639 (42.4%) had LN at registry enrollment. Mean age was 41.3 yrs, disease duration 9.4 yrs, 5.5 ACR Criteria, 2.6 SLEDAI score, and 1.1 SLICC-DI score. LN patients were younger at SLE diagnosis (26.2 vs 32.1 yrs, p<0.01) and 11.9% LN vs 6.0% non-LN patients were male (p<0.01). LN prevalence in non-Hispanic Blacks (49%) and Asians (53%) was higher than non-Hispanic Whites (32%, p<0.01 ).
LN and non-LN patients had similar prevalence of cardiovascular disease (7.4 vs. 8.0%, p=0.67), though LN patients had higher prevalence of hypertension (57.0% vs. 29.5%, p<0.01), hyperlipidemia (23.2% vs. 11.4%, p<0.01), and pre-eclampsia (10.0 vs. 5.7%, p<0.01). Asians with LN had a lower renal biopsy rate of 66.2% compared to non-Hispanic Blacks (79.3%, p=0.02). LN patients with a confirmatory renal biopsy were more likely to have received cyclophosphamide (CTX, 51.4% vs 34.4%, p=0.0002), mycophenolate (MMF, 75.0% vs 56.9%, p<0.0001), or both CTX and MMF in the past (38.4 vs 21.3%, p<0.0001) compared to non-biopsied LN patients.
Of 868 non-LN patients at enrollment, 10 (1.2%) developed LN over an average of 1.8 yrs follow-up. Of the 1348 with no renal damage at enrollment, 28 (2.1%) developed renal damage over an average of 1.8 yrs follow-up. Patients without renal damage at enrollment taking hydroxychloroquine (72.0% overall) had subsequently lower renal damage incidence (1.3% vs 4.0%, p=0.0023). Patients on MMF (26.3% overall) had higher incidence of renal damage (3.7% vs 1.5%, p=0.014) but no difference seen with CTX or azathioprine.
At enrollment, 55 patients had ESRD with an additional 14 incident cases over 2.5 yrs follow-up. Eight patients (12%) with low GFR vs 0.04% without low GFR by SDI at enrollment progressed to ESRD over an average of 1.8 yrs follow-up. Seven patients (15%) with proteinuria vs 0.5% without proteinuria by SDI at enrollment progressed to ESRD over an average of 1.8 yrs follow-up.
This study describes prevalent and incident characteristics of LN and renal damage among a large cohort of patients with SLE. Consistent with other cohorts, LN rates vary by race and hydroxychloroquine use appears to help protect from renal damage. Prior renal damage associated with progression to ESRD emphasizes the importance of early identification of high-risk SLE patients.
D. L. Kamen,
G. S. Alarcon,
J. P. Buyon,
M. A. Dooley,
R. A. Furie,
D. S. Pisetsky,
T. O. Utset,
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