Background/Purpose: To characterize the longitudinal trajectory of estimated glomerular filtration rate (eGFR) in patients with systemic lupus erythematosus (SLE) and identify predictors of change in eGFR trajectory.

Methods: All patients with SLE who participated in a large American Lupus Cohort in or after year 2006 were identified. Patients were followed until death, diagnosis of end-stage renal disease or renal failure, or the last follow-up date, whichever came first. The longitudinal eGFR level of patients were modelled by piecewise linear regression. We evaluated the slope of different line segments. The slopes were classified into declining (≤ -4 mL/min/1.73 m² per year), stable (-4 to 4 mL/min/1.73 m² per year), and increasing (≥4 mL/min/1.73 m² per year) states of eGFR. The transition rate between states and the impact of clinical parameters on transition rate were estimated using Proportional Hazards modeling. 

Results: We identified 494 SLE patients with 15,329 clinical visits over time. Two hundred and sixty-one (52.8%) patients were between 40 and 59 years old at the first clinical visit (baseline); 183 (37.0%) were younger than 40 years old; 50 (10.1%) were at or above 60 years old at baseline; 455 (92.1%) patients were female; 267 (54.0%) patients were Caucasian; 185 (37.4%) patients were African American. Their mean SLE disease activity index was 2.7 ± 3.4 at baseline. Three hundred and eight (62.3%) patients had an eGFR ≥90 mL/min/1.73 m2 at baseline; 152 (30.8%) had an eGFR between 60 and 89 mL/min/1.73 m2 at baseline; 34 (6.9%) had a baseline eGFR < 60 mL/min/1.73 m2. The eGFR trajectory of selected patients is shown in Figure 1. Of all patients, 34.4% experienced a declining state at some point in their follow-up. In patients with one transition, 43 (40.2%) changed from declining to stable state while 29 (27.1%) changed from stable to declining state. High blood pressure, low C4 and low hematocrit were associated with change from non-declining to declining state (Table 1). High urine protein-to-creatinine ratio also tended to be associated with change from non-declining to declining state. African American patients were less likely to move from declining to non-declining state. Use of prednisone was associated with change from declining to non-declining state (Table 2).

Conclusion: A declining eGFR trajectory is common in SLE patients. High blood pressure and urine protein-to-creatinine ratio, and low C4 and hematocrit are risk factors for transition from stable to declining GFR. Use of prednisone may attenuate the declining eGFR. These findings can help clinicians anticipate changes in GFR trajectory.

Table 1 GFR Abstract

Table 2 GFR Abstract

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/longitudinal-trends-for-estimated-glomerular-filtration-rate-and-predictors-of-change-in-patients-with-systemic-lupus-erythematosus/