Session Information
Date: Tuesday, November 15, 2016
Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment - Poster III: Biomarkers and Nephritis
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Patients with systemic lupus erythematosus (SLE) are at elevated risk for lupus nephritis and ultimately renal failure. While some risk factors for renal involvement among patients with SLE are well known, there has not been a recent systematic study of the relationship between SLE patient characteristics and renal failure. We leveraged a large American clinical cohort of patients with SLE to estimate the risk of renal failure within 10 and 20 years of diagnosis overall, and in subgroups defined by clinical and demographic patient characteristics.
Methods: This analysis is based on the time from SLE diagnosis until end of follow-up or renal failure for patients in our cohort. For patients diagnosed with SLE before entering our cohort, the data of diagnosis and clinical manifestations at the time of diagnosis were collected by a comprehensive history at cohort entry. Individuals with renal failure prior to SLE diagnosis were excluded. We estimated the risk of experiencing renal failure over time among all patients and within subgroups of patients using the Kaplan-Meier approach. Cox regression models were used to estimate the joint association between multiple patient characteristics and renal failure.
Results: Among the 2356 cohort patients included, 155 patients experienced renal failure after SLE diagnosis and before the end of their active participation in the cohort. Table 1 shows the relationship between selected patient characteristics and 10 and 20-year risk of renal failure. Table 2 shows association between patient characteristics and rates of renal failure based on a multivariate model. Table 1: Relationship between demographic factors and risk of renal failure in the Hopkins Lupus Cohort
| Subgroup | Estimated percent chance of developing renal failure within 10 years of SLE diagnosis (95% CI) | Estimated percent chance of developing renal failure within 20 years of SLE diagnosis (95% CI) | P-value (log-rank test) |
| Everyone (n=2356) |
5.8 (4.8, 6.9) |
9.6 (8.1, 11.5) |
|
| Sex Female (n=2179) Male (n=177) |
5.3 (4.3, 6.4) 12.2 (7.7, 19.1) |
9.4 (7.8, 11.4) 12.2 (7.6, 19.1) |
.021 |
| Age of diagnosis <30 (n=1170) 30-39 (n=586) 40+ (n=600) |
7.5 (6.0, 9.4) 5.2 (3.6, 7.7) 2.3 (1.3, 4.1) |
12.0 (9.7, 14.9) 8.2 (5.7, 11.7) 5.0 (2.7, 9.0) |
.0006 |
| Ethnicity White (n=1260) Black (n=920) Other (n=176) |
3.7 (2.7, 5.1) 8.5 (6.7, 10.8) 6.2 (3.2, 11.7) |
7.0 (5.2, 9.5) 13.0 (10.3, 16.3) 11.4 (5.3, 23.9) |
<.0001 |
| Year of Diagnosis <1985 (n=296) 1985-1994 (n=634) 1995-2004 (n=947) 2004-2015 (n=479) |
5.1 (3.1, 8.4) 6.5 (4.7, 8.9) 5.1 (3.8, 6.9) 4.8 (3.1, 8.4) |
11.3 (8.0, 15.8) 9.7 (7.3, 12.9) 6.5 (4.8, 8.8) 4.8 (3.0, 7.6) |
.40 |
| Low C3 (ever) No (n=1063) Yes (n=1287) |
2.4 (1.5, 3.8) 8.2 (6.7, 1.0) |
5.9 (3.9, 9.0) 12.3 (10.1, 14.9) |
<0.0001 |
| Low C4 (ever) No (1228) Yes (1121) |
3.7 (2.7, 5.1) 7.7 (6.2, 9.7) |
7.5 (5.4, 10.3) 11.7 (9.4, 14.4) |
0.0071 |
| Anti-dsDNA (ever +) No (n=894) Yes (n=1455) |
3.2 (2.1, 4.8) 7.1 (5.7, 8.7) |
6.4 (4.2, 9.9) 11.2 (9.2, 13.6) |
.0004 |
|
ACR Criteria satisfied at time of SLE Diagnosis |
|||
| Neurologic No (n=2218) Yes (n=138) |
5.5 (4.5, 6.7) 9.8 (5.6, 16.7) |
9.3 (7.7, 11.2) 15.6 (9.1, 25.8) |
0.012 |
| Photosensitivity No (n=1389) Yes (n=967) |
7.1 (5.7, 8.8) 3.9 (2.7, 5.5) |
11.9 (9.6, 14.6) 6.6 (4.8, 9.2) |
.0068 |
| Mucosal Ulcer No (n=1561) Yes (n=795) |
6.4 (5.2, 7.9) 4.5 (3.1, 6.6) |
10.5 (8.6, 12.9) 7.7 (5.2, 11.3) |
.049 |
| Arthritis No (n=1063) Yes (n=1296) |
7.0 (5.4, 8.9) 4.8 (3.6, 6.3) |
11.4 (8.9, 14.6) 8.2 (6.3, 10.6) |
.045 |
Table 2: Joint association between multiple variables and rates of renal failure based on a Cox regression model
| Variable | Rate Ratio (95% CI) | P-value |
| Male (vs. female) | 2.0 (1.2, 3.3) | 0.0069 |
| Age of diagnosis 30-39 (vs. < 30) 40+ (vs. < 30) | 0.8 (0.6, 1.2) 0.5 (0.3, 0.8) | 0.30 0.0048 |
| Race Black (vs. White) Other (vs. White) | 2.1 (1.5, 3.0) 1.5 (0.8, 2.9) | <0.0001 0.18 |
| History of anti-dsDNA (vs. no history) | 1.4 (0.9, 2.1) | 0.12 |
| History of low C3 | 1.8 (1.2, 2.7) | 0.0050 |
| Neurologic involvement at diagnosis | 1.7 (1.0, 2.9) | 0.061 |
| Musculoskeletal involvement at diagnosis | 0.7 (0.5, 1.0) | 0.045 |
Conclusion: Almost 10% of our patients develop renal failure within 20 years. Risk of renal failure is highest among males, African Americans, those diagnosed with SLE at a younger age, those with a history of low complement, anti-dsDNA and neurologic involvement. Those with musculoskeletal disease at SLE diagnosis appear to have lower risk.
To cite this abstract in AMA style:
Magder LS, Barr E, Petri M. Risk of Renal Failure within 10 or 20 Years of SLE Diagnosis, By Patient Characteristics [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/risk-of-renal-failure-within-10-or-20-years-of-sle-diagnosis-by-patient-characteristics/. Accessed .ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-of-renal-failure-within-10-or-20-years-of-sle-diagnosis-by-patient-characteristics/