Prevalence of lupus nephritis, end stage kidney disease, avascular necrosis, and mortality in systemic lupus erythematosus in the recent era

Takehiro Nakai¹, Sho Fukui², Yukihiko Ikeda³, Masei Suda⁴, Hiromichi Tamaki¹, mitsumasa kishimoto⁵ and Masato Okada⁶, ¹Immuno-Rheumatology Center, St. Luke’s International Hospital, Tokyo, Japan, ²Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, ³St Luke's international hospital in Japan, Tokyo, Japan, ⁴Suwa Central Hospital, Nagano, Japan, ⁵Kyorin University School of Medicine, Tokyo, Japan, ⁶St. Luke's International Hospital, Tokyo, Japan

Meeting: ACR Convergence 2025

Keywords: Mortality, prognostic factors, Renal, Systemic lupus erythematosus (SLE)

Session Information

Date: Sunday, October 26, 2025

Title: (0593–0640) Systemic Lupus Erythematosus – Diagnosis, Manifestations, & Outcomes Poster I

Session Type: Poster Session A

Session Time: 10:30AM-12:30PM

Background/Purpose: Systemic lupus erythematosus (SLE) is an autoimmune disease associated with an increased risk of chronic kidney disease (CKD), avascular necrosis (AVN), and mortality. Despite advancements in management, the contemporary prevalence and risk factors for these complications remain incompletely characterized. This study aimed to assess these outcomes within the context of modern SLE management.

Methods: We conducted a retrospective analysis of patients with SLE who received follow-up care at a tertiary referral center between April 2006 and February 2023. The prevalence and risk factors for lupus nephritis, progression to CKD stage 4 or 5, AVN, and all-cause mortality were evaluated using hazard ratios.

Results: Among 484 patients, lupus nephritis was observed in 26.2%, AVN in 4.8%, and CKD stage 4 or 5 in 2.9%, while the overall mortality rate was 2.5%. Lupus nephritis was more prevalent in patients diagnosed before age 20, whereas CKD progression and mortality were significantly higher in those with later-onset SLE. Hydroxychloroquine use was protective against CKD progression (HR 0.19, 95% CI 0.05–0.69, p = 0.012) and mortality (HR 0.14, 95% CI 0.031–0.66, p = 0.013). Methylprednisolone pulse therapy was associated with an increased risk of AVN (HR 6.10, 95% CI 2.42–15.35, p < 0.001).

Conclusion: Compared to historical cohorts, the prevalence of CKD stage 4 or 5, AVN, and mortality has declined in this cohort. Hydroxychloroquine improves outcomes by reducing CKD progression and mortality, while caution is warranted with methylprednisolone pulse therapy due to its association with AVN.

Figure 1 Hydroxychloroquine prescription and its impact on cumulative incidence of CKD stage 4 or 5 and all-cause mortality

(A) Hydroxychloroquine prescription and its impact on cumulative incidence of CKD stage 4 or 5

(B) Hydroxychloroquine prescription and its impact on cumulative incidence of all-cause mortality

Table 1: Hazard ratio of incidence of CKD stage 4 or 5

Table 2: Hazard ratio of incidence of all cause death

Disclosures: T. Nakai: None; S. Fukui: None; Y. Ikeda: None; M. Suda: None; H. Tamaki: AbbVie/Abbott, 6, Astellas Pharma, 6, Ayumi Pharma, 6, Chugai pharmaceutical, 6, Dai-ichi-Sankyo, 12, Personal Fees, Eisai, 12, Personal Fees, GSK, 12, Personal Fees, Illy-lily, 12, Personal Fees, Kyowa-KIrin, 6, Ono pharmaceutical, 6, Pfizer, 12, Personal Fees, Takeda Pharmaceutical, 6, Tanabe-Mitsubishi, 6; m. kishimoto: AbbVie, 2, 6, Amgen, 2, 6, Asahi-Kasei Pharma, 2, 6, Astellas, 2, 6, Ayumi, 2, 6, BMS, 2, 6, Celgene, 2, 6, Chugai, 2, 6, Daiichi-Sankyo, 2, 6, Eisai, 2, 6, Eli Lilly, 2, 6, Gilead, 2, 6, Johnson & Johnson, 2, 6, Kyowa Kirin, 2, 6, Novartis, 2, 6, Ono Pharma, 2, 6, Takeda, 2, 6, Tanabe-Mitsubishi, 2, 6, UCB, 2, 6; M. Okada: Abbott, 6, Eli Lilly, 6, Mitsubishi Tanabe Pharma, 6, Pfizer, 6, Santen Pharmaceutical, 6.

To cite this abstract in AMA style:

Nakai T, Fukui S, Ikeda Y, Suda M, Tamaki H, kishimoto m, Okada M. Prevalence of lupus nephritis, end stage kidney disease, avascular necrosis, and mortality in systemic lupus erythematosus in the recent era [abstract]. Arthritis Rheumatol. 2025; 77 (suppl 9). https://acrabstracts.org/abstract/prevalence-of-lupus-nephritis-end-stage-kidney-disease-avascular-necrosis-and-mortality-in-systemic-lupus-erythematosus-in-the-recent-era/. Accessed .

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