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Association of rheumatoid arthritis with mortality in chronic kidney disease: a cohort study

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Abstract

Background

Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD) as well as with an increased risk of chronic kidney disease (CKD), also a known cardiovascular risk factor. However, it is not known if RA is a predictor of adverse outcomes in patients with CKD. We hypothesized that among a cohort of patients with CKD, RA would be associated with an increased risk of mortality.

Materials and methods

We conducted a retrospective study of 3939 participants with CKD from the prospective Chronic Renal Insufficiency Cohort (CRIC) study. The primary outcome of interest was all-cause mortality. Secondary outcomes included CKD progression (defined as end-stage kidney disease or 50% decline in estimated glomerular filtration rate), cardiovascular endpoints, and composite of myocardial infarction, cerebrovascular accident, heart failure, or death. Multivariable Cox proportional hazards regression was utilized, adjusting for potential confounders including age, sex, race/ethnicity, body mass index, current smoker, and education.

Results

The study cohort included 83 participants with RA on a disease modifying anti-rheumatic drug (DMARD). In the adjusted analysis, CKD-RA status was significantly associated with an increased risk of death (adjusted HR, aHR, 1.73 (1.27, 2.35)) and composite outcome (aHR 1.65 (1.27–2.15)) even after adjusting for traditional risk factors. Similar statistically significant associations were observed between CKD-RA and other secondary outcomes except for CKD progression.

Conclusion

RA was associated with higher mortality among individuals with CKD but not progressive renal decline. Further studies evaluating the mechanisms behind this association are needed.

Key Points

• Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD) as well as with an increased risk of chronic kidney disease (CKD), also a known cardiovascular risk factor. However, it is not known if RA is an independent predictor of adverse outcomes in patients with CKD

• In this study, we observed that CKD patients with RA experience higher mortality as well as an increased risk of CVD compared to patients with CKD without comorbid RA

• These data provide rationale for more aggressive monitoring for CVD in patients with CKD and RA. They also underscore the need for determining which interventions can help decrease the burden of mortality in these patients

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Acknowledgements

The Chronic Renal Insufficiency Cohort Study (CRIC) was conducted by the CRIC Study Investigators and supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The data from the CRIC reported here were supplied by the NIDDK Central Repositories. This manuscript was not prepared in collaboration with Investigators of the CRIC study and does not necessarily reflect the opinions or views of the CRIC study, the NIDDK Central Repositories, or the NIDDK.

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Authors and Affiliations

  1. Division of Rheumatology, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA

    Mary N. Ezeanuna & Namrata Singh

  2. Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, WA, USA

    David K. Prince & Nisha Bansal

  3. Department of Internal Medicine, University of Connecticut, Farmington, CT, USA

    Swetha Ann Alexander

  4. Rheumatology Section, Medicine Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA

    John S. Richards

  5. Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    John S. Richards

  6. Rheumatology Section, Washington, DC Veterans Affairs, Division of Rheumatology, Georgetown and Howard University Hospitals, Washington, DC, USA

    Gail S. Kerr

  7. Division of Nephrology, University of Iowa Hospitals and Clinics and Iowa City VA Medical Center, Iowa City, IA, USA

    Diana Jalal

  8. Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA

    Jean W. Liew

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  1. Mary N. Ezeanuna
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Correspondence to Namrata Singh.

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This study was presented as a poster at the EULAR 2021 virtual Congress. Citation: Ann Rheum Dis, volume 80, supplement 1, year 2021, page 476.

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Ezeanuna, M., Prince, D., Alexander, S. et al. Association of rheumatoid arthritis with mortality in chronic kidney disease: a cohort study. Clin Rheumatol 41, 2669–2676 (2022). https://doi.org/10.1007/s10067-022-06223-x

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  • DOI: https://doi.org/10.1007/s10067-022-06223-x

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