Session Type: Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Chronic kidney disease (CKD) is a common comorbidity of rheumatoid arthritis (RA) affecting 10-20% of patients. However, the influence of the longitudinal RA disease activity on the long-term prognosis of kidney function has not been thoroughly evaluated.
Methods: We conducted a longitudinal study using the prospective CorEvitas RA registry and included patients with eGFR ≧60 mL/min/1.73 m2 at baseline for whom kidney function was recorded at least twice from 2001 to 2022. The primary outcome was eGFR change from the baseline visit; secondary outcome was development of CKD G3b or worse (eGFR < 45 mL/min/1.73 m2 for more than 3 months). The category of time-averaged Clinical Disease Activity Index (CDAI) until each visit was an exposure of interest. We used all visit data in primary analyses, and data only from patient visits where time-averaged CDAI was stable in one category from the baseline were used in secondary analyses. Multivariable mixed-effect random intercept and slope model with the interaction term of time and time-averaged CDAI was used to evaluate the association between CDAI categories and changes in the slope of eGFR. We adjusted for baseline variables including age, sex, race, eGFR, RF/CCP, and secondary Sjogren’s syndrome. Body mass index, smoking status, modified Health Assessment Questionnaire, C-reactive protein, comorbidities, and the use of medications (non-steroidal anti-inflammatory drugs, glucocorticoids, and each of disease-modifying antirheumatic drugs) were included as time-varying covariates. Kaplan-Meier curves and multivariable Cox proportional hazard models were used to evaluate the hazard ratio (HR) of time-averaged CDAI categories for the development of CKD G3b or worse renal function. We adjusted for baseline covariates in the survival analyses.
Results: We included 31,129 patients with 234,973 visits in the analyses. The mean (standard deviation) age was 57.3 (12.9) years, and 23,758 (76.3%) were female with a median follow-up of 3.5 years. The mean baseline eGFR was 90.2 ml/min/1.73 m2 (Table 1). The mixed-effect model showed that the annual eGFR decline was -0.855 mL/min/1.73 m2 in RA remission. Patients with low, moderate, and high disease activity had additional -0.070, -0.150, and -0.168 ml/min/1.73 m2 declines annually vs. patients in remission. Secondary analyses revealed larger differences in the eGFR slopes between time-averaged CDAI categories (Table 2). Kaplan-Meier curve showed RA patients with higher disease activity developed more CKD G3b (Figure 1). Adjusted HRs (95%CI) were 1.12 (0.77-1.63) in low, 1.47 (1.00-2.20) in moderate, and 1.84 (1.11-3.05) in high disease activity patients for CKDG3b.
Conclusion: After adjusting for potential confounders, RA patients with higher disease activity had a larger decline in eGFR and developed clinically significant CKD more frequently. This study suggests that controlling the disease activity of RA may potentially improve renal prognosis.
To cite this abstract in AMA style:Fukui S, Winkelmayer W, Tedeschi S, Marrugo J, Guan H, Harrold L, Litman H, Shinozaki T, Solomon D. The Relationship Between Disease Activity of Rheumatoid Arthritis and Kidney Function [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/the-relationship-between-disease-activity-of-rheumatoid-arthritis-and-kidney-function/. Accessed .
« Back to ACR Convergence 2023
ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-relationship-between-disease-activity-of-rheumatoid-arthritis-and-kidney-function/