Background/Purpose: Renal disease is prevalent in patients with rheumatoid arthritis (RA), although the precise prevalence of RA has not been determined. Increased mortality in patients with RA is associated with concurrent renal diseases. Impaired renal function in patients with RA is likely due to a chronic inflammatory response, antirheumatic drug toxicity, and renal involvement of RA itself. The effect of biological disease-modifying antirheumatic drugs (bDMARDs) on renal function in patients with RA has not been well establisehd. We assessed whether tumor necrosis factor (TNF) inhibitors could affect renal function in RA.

Methods: A total of 2110 patients with RA enrolled in the Korean College of Rheumatology Biologics (KOBIO) registry were analyzed. All patients were taking bDMARDs or conventional synthetic DMARDs (csDMARDs). Renal function was evaluated by calculating the estimated glomerular filter rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) equation. Renal insufficiency was defined as eGFR < 60 mL/min/1.73 m². Differences in eGFR changes between different types of DMARDs were assessed at each follow-up time using the generalized linear model (GLM) method. Risk factors for renal insufficiency were identified using binary logistic regression analysis.

Results: The changes of eGFR values in patients treated with TNF inhibitors were not significantly different from those with csDMARDs alone or non-TNF inhibitors in all RA patients regardless of renal function. Among patients with renal insufficiency, GLM analysis revealed that the changes of eGFR values by TNF inhibitors were also compatible to those treated with csDMARDs alone or non-TNF inhibitors. Older age (> 55 years), longer disease duration (> 5 years), and use of methotrexate were identified as clinical determinants for renal insufficiency.

Conclusion: TNF inhibitors did not influence the change of renal function during RA treatment. TNF inhibitors may be a safe treatment option irrespective of renal function.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/no-effect-of-tumor-necrosis-factor-a-inhibitors-on-renal-function-in-patients-with-rheumatoid-arthritis-from-kobio-registry-from-2012-to-2016/