ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 961

Outcome of Lupus Nephritis and Impact on Health Related Quality of Life: Results from an International, Prospective, Inception Cohort Study

John G. Hanly for the Systemic Lupus International Collaborating Clinics1, Aidan O'Keeffe2, Li Su3, Murray B. Urowitz4, Juanita Romero-Diaz5, Caroline Gordon6, Sang-Cheol Bae7, Sasha R Bernatsky8, Ann E. Clarke9, Daniel J. Wallace10, Joan T. Merrill11, David A. Isenberg12, Anisur Rahman13, Ellen M. Ginzler14, Paul Fortin15, Dafna D. Gladman4, Jorge Sanchez-Guerrero16, Michelle Petri17, Ian Bruce18, Mary Anne Dooley19, Rosalind Ramsey-Goldman20, Cynthia Aranow21, Graciela S. Alarcon22, Barri Fessler23, Kristjan Steinsson24, Ola Nived25, Gunnar Sturfelt25, Susan Manzi26, Munther A. Khamashta27, Ronald F. van Vollenhoven28, Asad Zoma29, Manuel Ramos-Casals30, Guillermo Ruiz-Irastorza31, S. Sam Lim32, Thomas Stoll33, Murat Inanc34, Kenneth C. Kalunian35, Diane L. Kamen36, Peter Maddison37, Christine A. Peschken38, Søren Jacobsen39, Anca Askanase40, Jill P. Buyon41, Chris Theriault42, Kara Thompson42 and Vernon Farewell3, 1Division of Rheumatology, Dalhousie University and Capital Health, Nova Scotia, Canada, Halifax, NS, Canada, 2MRC Biostatistics Unit, Institute of Public Heath, Cambridge, United Kingdom, 3MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Cambridge, United Kingdom, 4University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, 5Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutricion, Mexico city, Mexico, 6Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom, 7Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea, 8Division of Rheumatology and Clinical Epidemiology, McGill University, Montreal, Quebec, QC, Canada, 9Division of Rheumatology, University of Calgary, Alberta, Calgary, AB, Canada, 10Rheumatology, Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA, 11Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, 12Centre for Rheumatology Research, Rayne Building, 4th Floor, Centre for Rheumatology, Department of Medicine, University College London, London, United Kingdom, 13Centre for Rheumatology Research, University College London, London, United Kingdom, 14Rheumatology, SUNY-Downstate Medical Center, Brooklyn, NY, 15Medicine, Division of Rheumatology, Centre Hospitalier Universitaire de Quebec et Universite Laval, Quebec, QC, Canada, 16Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada, 17Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, 18Kellgren Centre for Rheum, Arthritis Research UK Epidemiology Unit, Institution of Inflammation and Repair, University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals, Manchester Academic Health Sciences Centre, Manchester, United Kingdom, 19Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, 20Rheumatology, Northwestern University and Feinberg School of Medicine, Chicago, IL, 21Feinstein Institute for Medical Research, Mahasset, NY, 22Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, 23Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, 24Center for Rheumatology Research, Landspitali University Hospital, Reykjavik, Iceland, 25Department of Rheumatology, University Hospital Lund, Lund, Sweden, 26Division of Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 27Lupus Research Unit, The Rayne Institute, St Thomas Hospital, Kings College London School of Medicine, London, United Kingdom, 28Unit for clinical therapy research (ClinTrid), Karolinska Institute, Stockholm, Sweden, 29Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, United Kingdom, 30Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain, 31Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain, 32Emory University School of Medicine, Division of Rheumatology, Atlanta, GA, 33Kantonsspital Geissbergstr, Schaffhausen, Switzerland, 34Division of Rheumatology, Department of Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey, 35UCSD School of Medicine, La Jolla, CA, 36Department of Medicine, Division of Rheumatology, Medical University of South Carolina, Charleston, SC, 37Ysbyty Gwynedd Bangor, North Wales, United Kingdom, 38Rheumatology, University of Manitoba, Winnipeg, MB, Canada, 39Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark, 40Columbia University Medical Center, New York, NY, 41Department of Medicine, Division of Rheumatology, New York University School of Medicine, New York, NY, 42Department of Medicine, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment: Lupus Nephritis

Session Type: Abstract Submissions (ACR)

Background/Purpose: Improved immunosuppressive therapies have changed the treatment of lupus nephritis (LN) over the past decade. We examined the outcome of LN with current standard of care in an inception cohort of SLE patients. 

Methods: An observational study of new onset SLE was performed by an international network of 32 centers. Patients were evaluated at enrollment and annually. LN was identified as “renal disorder” (ACR classification criterion) and/or biopsy confirmation. Data included medications, estimated glomerular filtration rate (eGFR) and proteinuria (ePrU), end-stage renal disease (ESRD), SLE disease activity index-2000 (SLEDAI-2K) and Systemic Lupus International Collaborating Clinics (SLICC)/ACR damage index (SDI). GFR states were defined: state 1 (eGFR: >60 ml/min); state 2 (eGFR: 30–60 mL/min); and state 3 (eGFR: <30 ml/min). Similarly, PrU states were defined: state 1 (ePrU: <0.25 gr/day); state 2 (ePrU: 0.25–3.0 gr/day); and state 3 (ePrU: >3.0 gr/day). HRQoL was determined by SF-36 subscale, mental (MCS) and physical (PCS) component summary scores. Statistical analyses included analysis of variance or equivalent t-tests, Chi-squared test, regression and Kaplan-Meier curves. 

Results: Of 1,827 SLE patients, 89% were female, 49.2% Caucasian with mean±SD age 35.1±13.3 years. At enrollment, mean SLE duration was 0.5±0.3 years, SLEDAI-2K was 5.4±5.4, SDI was 0.3±0.7. The mean follow-up was 4.6±3.4 years. LN occurred in 700/1,827 (38.3%) patients: 566 (31%) at enrollment and 134 (7.3%) during follow-up. It was more common in Hispanics (49.3%), African ancestry (39.9%) and Asians (36.8%) compared to Caucasians (20.3%) (p<0.001). Renal biopsies from 395 (56.4%) patients revealed ISN classes (%): I: 9 (2.4), II: 36 (9.5), III: 101 (26.8), IV: 163 (43.2), V: 121 (32.1) and VI: 3 (0.8); 21 and 34 biopsies had class III/V and IV/V respectively. At presentation, impaired renal function (eGFR <60 ml/min) occurred in 12.9% and proteinuria (ePrU of >0.25 gr/day) in 55.1% of patients with LN. Medications in LN patients were corticosteroids 651/700 (93%), antimalarials 517/700 (73.9%) and immunosuppressive (cyclophosphamide, azathioprine, mycophenolate mofetil) drugs in 614/700 (87.7%). At final follow-up 113/685 (16.5%) patients with LN had impaired renal function and 417/671 (62.1%) had proteinuria. Following LN the estimated 10 year incidence of ESRD was 10.1% (95%CI: (6.6%, 13.6%)) and there was a higher risk of death (HR=2.98, 95%CI (1.48, 5.99), p=0.002). Patients with eGFR <30 ml/min at diagnosis had lower SF-36 PCS scores (p<0.01) and lower Physical function, Physical role and Bodily pain scores. Over time, patients with abnormal eGFR and ePrU had lower SF-36 MCS (p ≤0.02) scores compared to patients with normal values. 

Conclusion: LN occurred in 38.3% of SLE patients, frequently as the initial presentation, in a large multi-ethnic inception cohort. Despite current standard of care, nephritis was associated with ESRD and death, and renal insufficiency was linked to lower HRQoL. New strategies are required to improve outcomes of lupus nephritis.

Disclosure:

J. G. Hanly for the Systemic Lupus International Collaborating Clinics,
None;

A. O’Keeffe,
None;

L. Su,
None;

M. B. Urowitz,
None;

J. Romero-Diaz,
None;

C. Gordon,
None;

S. C. Bae,
None;

S. R Bernatsky,
None;

A. E. Clarke,
None;

D. J. Wallace,
None;

J. T. Merrill,
None;

D. A. Isenberg,
None;

A. Rahman,
None;

E. M. Ginzler,
None;

P. Fortin,
None;

D. D. Gladman,
None;

J. Sanchez-Guerrero,
None;

M. Petri,
None;

I. Bruce,
None;

M. A. Dooley,
None;

R. Ramsey-Goldman,
None;

C. Aranow,
None;

G. S. Alarcon,
None;

B. Fessler,
None;

K. Steinsson,
None;

O. Nived,
None;

G. Sturfelt,
None;

S. Manzi,
None;

M. A. Khamashta,
None;

R. F. van Vollenhoven,
None;

A. Zoma,
None;

M. Ramos-Casals,
None;

G. Ruiz-Irastorza,
None;

S. S. Lim,
None;

T. Stoll,
None;

M. Inanc,
None;

K. C. Kalunian,
None;

D. L. Kamen,
None;

P. Maddison,
None;

C. A. Peschken,
None;

S. Jacobsen,
None;

A. Askanase,
None;

J. P. Buyon,
None;

C. Theriault,
None;

K. Thompson,
None;

V. Farewell,
None.

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