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Evolution of chronic kidney disease in patients with systemic lupus erythematosus over a long-period follow-up: a single-center inception cohort study

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Abstract

The objective is to investigate the accrual rate and risk factors of chronic kidney disease (CKD) in an inception cohort of patients with systemic lupus erythematosus (SLE) followed at a single tertiary center. A prospectively collected database of 256 consecutive patients with SLE followed over a 25-year period was systematically interrogated for demographic, disease manifestations, co-morbidities, and outcome. Standardized SLE activity and damage scores were determined for the first and last study visits, and estimated glomerular filtration rate (eGFR; MDRD formula) was calculated at the time of diagnosis and at each year of the follow-up. CKD was defined as eGFR <60 ml/min/1.73 m2. Results were analyzed with univariate and multivariate models and Kaplan-Meier curves, as appropriate. The cohort was predominantly female (90 %) and Jewish (91.1 %). Mean age at diagnosis was 38 ± 15.5 years, mean SLE activity score 6.4 ± 3.8, mean disease duration 8.8 ± 6.6 years, and mean damage score 0.2 ± 0.6. Seventy-five patients (30.8 %) were diagnosed with American College of Rheumatology (ACR)-defined lupus renal disease during the study period. There was a progressive decrease in eGFR over time. The prevalence of CKD was 46.7 % in patients with ACR-defined renal lupus disease and 16.4 % in those without. The hazards ratio for CKD was significantly higher in patients with lupus nephritis (LN) than without (p < 0.001). Earlier CKD was positively associated with hypertension (p = 0.01), older age at diagnosis (p = 0.01), and LN (p < 0.001), and negatively associated with hydroxychloroquine treatment (p < 0.001). The prevalence of CKD increases cumulatively in patients with SLE, also in those without overt lupus renal disease. Lupus renal disease poses a significant hazard for earlier development of CKD, and hypertension is a major risk factor for patients with and without nephritis. Antimalarial treatment is associated with renal preservation only in patients with lupus nephritis.

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The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Lupus Clinic, Rheumatology Unit, Beilinson Hospital, Rabin Medical Center, Beilinson Campus, Petach Tikva, 49100, Israel

    Elisheva Pokroy-Shapira & Yair Molad

  2. Statistical Laboratory School of Mathematics, Tel Aviv University, Tel Aviv, Israel

    Ilana Gelernter

  3. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Ilana Gelernter & Yair Molad

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  1. Elisheva Pokroy-Shapira
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  2. Ilana Gelernter
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  3. Yair Molad
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Correspondence to Yair Molad.

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Pokroy-Shapira, E., Gelernter, I. & Molad, Y. Evolution of chronic kidney disease in patients with systemic lupus erythematosus over a long-period follow-up: a single-center inception cohort study. Clin Rheumatol 33, 649–657 (2014). https://doi.org/10.1007/s10067-014-2527-0

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  • DOI: https://doi.org/10.1007/s10067-014-2527-0

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