Session Information
Date: Tuesday, November 10, 2015
Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment Poster Session III
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: The tempo of Complete Proteinuria Recovery (CPR) in Lupus Nephritis (LN) is slow and while 28% achieve CPR at year 1 this increases to 52% at year 2. The long term outcomes of patients who achieve CPR or Partial Proteinuria Recovery (PPR) of≥ 50% at 2 years is not well studied.
To determine the prognostic value of PPR and CPR at 2 years on long term outcomes compared to patients who did not recover proteinuria ≥ 50% on the standard of care therapy.
Methods: All patients that are registered at a large lupus clinic from 1970–2015 were reviewed (n=1782) and patients with LN were identified. LN was defined as: Proteinuria ≥0.5g/24 hours or spot Urine Protein Creatinine Ratio≥ 0.6mg/mg on 2 consecutive occasions within one year. Patients who achieved PPR or CPR within 2 years and have at least 5 years of follow up since the onset of LN were studied.
Endpoints:CPR was defined as proteinuria <0.5g/24 hours or PCR<0.6 mg/mg at least on 2 occasions. PPR was a decrease of ≥50% but not to normal levels. Not recovered was defined as <50% improvement.
Long term outcomes:Death, eGFR<15, dialysis or kidney transplant, damage [SLICC Damage Index (SDI)] >0 and >3) and atherosclerotic events occurring after achieving PPR or CPR.
Analyses:Non-parametric tests, survival analyses and simple cox regression were used to study the effect of PPR/CPR on outcomes.
Results: 326 patients (85% F) with LN were studied. The age at LN onset was 34.56 ± 12.19 yrs and lupus duration at LN onset was 5.72 ± 6.71 yrs. Follow up duration from lupus nephritis was 14.97 ± 8.95 yrs.
Endpoints at 2 years: 178 had CPR, 43 PPR and 105 did meet the endpoints.
The prevalence of comorbidities(except damage) was the lowest in the CPR group, slightly higher in the PPR group and the highest in the no remission group (table 1).
Although CPR protects against the development of comorbidities (death, end stage kidney disease, dialysis and transplant, and atherosclerosis), PPR does not. Damage accrual was not protected by CPR or PPR.
Table 1. Long term outcomes among 3 groups
|
Outcomes |
No remission N = 105 (n and %) |
PPR N = 43 (n and %) |
CPR N = 178 (n and %) |
|
Death |
25 (23.8) |
7 (16.3) |
21 (11.8) |
|
eGFR < 15 |
17 (16.2) |
9 (20.9) |
10 (5.6) |
|
Dialysis or Transplant |
15 (14.3) |
8 (18.6) |
10 (5.6) |
|
SDI > 0 |
86 (81.9) |
36 (83.7) |
129 (72.5) |
|
SDI > 3 |
30 (28.6) |
20 (46.5) |
44 (24.7) |
|
Atherosclerotic Events |
22 (20.9) |
5 (11.6) |
21 (11.8) |
Table 2. Effects of CPR and PPR on long term outcomes (simple cox regression)
|
Outcomes |
Comparisons |
Hazard Ratio |
95% CI |
P value |
|
Death |
PPR to no remission |
0.68 |
0.29-1.57 |
0.36 |
|
CPR to no remission |
0.54 |
0.30-0.96 |
0.035 |
|
|
eGFR < 15 |
PPR to no remission |
1.27 |
0.56-2.84 |
0.57 |
|
CPR to no remission |
0.33 |
0.15-0.72 |
0.005 |
|
|
Dialysis or Transplant |
PPR to no remission |
1.31 |
0.55-3.08 |
0.54 |
|
CPR to no remission |
0.41 |
0.19-0.92 |
0.03 |
|
|
SDI > 0 |
PPR to no remission |
0.98 |
0.66-1.45 |
0.93 |
|
CPR to no remission |
0.91 |
0.69-1.19 |
0.48 |
|
|
SDI > 3 |
PPR to no remission |
1.43 |
0.80-2.53 |
0.23 |
|
CPR to no remission |
0.838 |
0.52-1.34 |
0.46 |
|
|
Atherosclerotic Events |
PPR to no remission |
0.434 |
0.16-1.18 |
0.10 |
|
CPR to no remission |
0.509 |
0.27-0.95 |
0.033 |
Conclusion: Achieving CPR at 2 years, from the onset of LN, protects against comorbidities. PPR at 2 years doesn’t protect against comorbidities, thus physicians should aim to achieve CPR to prevent comorbidities in LN patients.
To cite this abstract in AMA style:
Touma Z, Urowitz M, Medina-Rosas J, Su J, Gladman D. Do Patients with Lupus Nephritis Who Achieve Complete Proteinuria Recovery at 2 Years Have Better Long Term Outcomes Compared to Patients with Partial Proteinuria Recovery? [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/do-patients-with-lupus-nephritis-who-achieve-complete-proteinuria-recovery-at-2-years-have-better-long-term-outcomes-compared-to-patients-with-partial-proteinuria-recovery/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/do-patients-with-lupus-nephritis-who-achieve-complete-proteinuria-recovery-at-2-years-have-better-long-term-outcomes-compared-to-patients-with-partial-proteinuria-recovery/