The Burden of Chronic Kidney Disease in Systemic Lupus Erythematosus (SLE): A Nationwide Epidemiologic Study

Arthur Mageau¹, Jean Francois Timsit¹, Anne Perozziello¹, Stephane Ruckly¹, Claire Dupuis¹, Lila Bouadma¹, Thomas Papo¹ and Karim Sacre², ¹Université Paris-Diderot, Paris, France, ²Bichat Hospital, Paris Diderot University, Paris, France

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Lupus, outcomes, population studies and renal disease

Session Information

Date: Sunday, October 21, 2018

Title: Systemic Lupus Erythematosus – Clinical Poster I: Clinical Manifestations and Comorbidity

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Lupus nephritis occurs in about 50% of SLE patients. We aimed to analyze the impact of chronic kidney disease (CKD) on major clinical outcomes in SLE by using a nationwide medico-administrative database.

Methods: We performed a retrospective cohort study to analyse hospital stays’ characteristics of SLE population in France from January 1st, 2009 to December 31st, 2015. We extracted data from the PMSI database (Programme de Médicalisation des Systèmes d’Informations) which compiles hospital discharges of all French healthcare facilities. PMSI uses International Classifications of Diseases 10^th revision (ICD-10) to encode diagnosis. All the diagnosis and procedures performed during hospital stays associated with or following a “M32” diagnosis code, which defines the SLE population, were identified. Factors associated with major clinical outcomes such as death, end-stage renal disease (ESRD), septic shock, and cardiovascular event were assessed. Kaplan-Meïer method was used to represent survival without major clinical outcomes according to the presence of CKD (eGFR <60mL/min/1.73m²) at first stay.

Results: From 2009 to 2015, 145 794 hospital stays associated with SLE diagnosis corresponding to 26 320 unique SLE patients were identified. Mean age [SD] at first stay was 46.7 [+/-17.2] and 85.6% were female. Among patients with kidney disease at first stay, 20.8% developed end-stage renal disease (ESRD) during follow up. Overall, from 2009 to 2015, death, septic shock, and cardiovascular event occurred in 6.7%, 4.5% and 10.5% of SLE patients, respectively. CKD identified at first stay in 2009 was significantly associated with the occurrence of death (RR 2.4 [2.0-2.9]), ESRD (RR 4.02 [2.86-5.65]), septic shock (RR 3.1 [2.3-4.2]), and cardiovascular event (RR 1.9 [1.6-2.3]) between 2009 and 2015.

Conclusion: Our results confirm at a nationwide level that CKD is a major risk factor for overall morbidity and mortality in SLE patients, highlighting the need for early pre-CKD lupus nephritis diagnosis.

Occurrence of death (A), ESRD (B), cardiovascular event (C) and septic shock (D) between 2009 and 2015 according to CKD status (eGFR <60mL/min/1.73m²) at first stay in 2009. Blue lines represent the outcome in patients without CKD at first stay. Red lines represent the outcomes in patients with CKD at first stay

Disclosure: A. Mageau, None; J. F. Timsit, None; A. Perozziello, None; S. Ruckly, None; C. Dupuis, None; L. Bouadma, None; T. Papo, None; K. Sacre, None.

To cite this abstract in AMA style:

Mageau A, Timsit JF, Perozziello A, Ruckly S, Dupuis C, Bouadma L, Papo T, Sacre K. The Burden of Chronic Kidney Disease in Systemic Lupus Erythematosus (SLE): A Nationwide Epidemiologic Study [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/the-burden-of-chronic-kidney-disease-in-systemic-lupus-erythematosus-sle-a-nationwide-epidemiologic-study/. Accessed .

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