Session Title: SLE – Clinical Poster I: Epidemiology & Pathogenesis
Session Type: Poster Session (Sunday)
Session Time: 9:00AM-11:00AM
Background/Purpose: Lupus nephritis and renal damage are serious complications in patients with SLE. Proteinuria < 0.8 g/24 hours at 12 months has proven to be a good predictor of long-term renal outcome. The aim of this study is to identify the predictors of renal damage in Latin American SLE patients.
Methods: Patients with lupus nephritis from a multiethnic, multinational, multicenter cohort were included in this study. Lupus nephritis was defined clinically (proteinuria greater than 0.5 g/day on two or more occasions or the presence of red cell casts) or histologically (renal biopsy compatible with lupus nephritis histopathology class II-V according to the World Health Organization). The following time-dependent variables were considered as possible predictors of renal damage: proteinuria, low complement, anti-dsDNA, red cell casts, creatinine level, hypertension, the renal component of the SLEDAI, prednisone dose, immunosuppressive drugs use, and antimalarial use. The following baseline variables were also included: gender, age at nephritis diagnosis, residence rural or urban, ethnic group and socioeconomic status (SES). Proteinuria was assessed at baseline and after 12 months, to determine if early response (proteinuria < 0.8 g/d within 12 months since the diagnosis of lupus nephritis) is protective of renal damage occurrence in SLE patients; renal damage was defined as an increase of at least one point in the renal domain of the SLICC/ACR damage index. Univariable and multivariable Cox regression models using a backward selection method with alpha-level to stay in the model set at 0.05 were performed.
Results: Four hundred and ninety patients were included; 89.4% of them (n = 438) were female, with a median age at SLE diagnosis of 26.4 IQR (19.0-36.0) years and median age at nephritis diagnosis of 27.5 (20.3-37.4) with a median follow-up after nephritis diagnosis of 3.9 (2.0-5.6) years. At baseline, the median creatinine was 0.9 (0.7-1.1) mg/dl. One-hundred and twenty patients (24.5%) accrued renal damage during their follow-up.
Early response to treatment (as defined) (HR 0.604), and antimalarial use (HR 0.477) were protective of the occurrence of renal damage whereas male gender (HR 1.930), low socioeconomic status (HR 3.945), hypertension (HR 1.854) and the renal component of the SLEDAI (HR 1.768) were risk factors for renal damage occurrence. Univariable and multivariable models are depicted in table 1.
Conclusion: Early response and antimalarial use were protective of renal damage occurrence, while male gender, hypertension, low socioeconomic status, higher renal domain of SLEDAI were risk factors for its occurrence in SLE patients. Strict control of modifiable risk factors such as early proteinuria response, antimalarial use and hypertension control, is therefore strongly recommended for patients with lupus nephritis to minimize damage.
To cite this abstract in AMA style:Reátegui-Sokolova C, Ugarte-Gil M, Harvey G, Pons-Estel G, Quintana R, Catoggio L, Soriano E, Garcia M, Saurit V, Caeiro F, Bonfa E, da Silva N, Sato E, Vasquez G, Massardo L, Neira O, Cardiel M, Garcia De-La Torre I, Amigo M, Guibert-Toledano M, Portela-Hernandez M, Chacon-Diaz R, Alarcón G, Pons-Estel B. Predictors of Renal Damage in Systemic Lupus Erythematosus Patients from Latin America [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/predictors-of-renal-damage-in-systemic-lupus-erythematosus-patients-from-latin-america/. Accessed January 30, 2023.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictors-of-renal-damage-in-systemic-lupus-erythematosus-patients-from-latin-america/