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219 Effect of complete or partial proteinuria recovery compared to no recovery at 2 years after the diagnosis of lupus nephritis on long term outcomes
  1. J Medina-Rosas1,
  2. D Gladman1,
  3. J Su2,
  4. M Urowitz1 and
  5. Z Touma1
  1. 1University of Toronto, Medicine- Rheumatology, Toronto, Canada
  2. 2University Health Network, Rheumatology, Toronto, Canada

Abstract

Background and aims To evaluate the effect of Complete Recovery (CR), Partial Recovery (PR), and No Recovery (NR) at 2 years from diagnosis of LN on long term outcomes.

Methods Patients with LN (proteinuria in 24 hour urine [24H-P]>0.5 g/day) were studied. At 2 years from LN, patients were divided into CR, PR and NR. Long-term outcomes were studied up to 15 years. CR was defined as normal 24H-P, PR as a reduction ≥50% in 24H-P without achieving CR and NR as a reduction <50% 24 hour-P compared to baseline. Long term outcomes: Renal outcomes (low eGFR <15 mL/min, end-stage renal disease requiring dialysis or transplantation [ESRD], and a Composite Renal Outcome [low eGFR or ESRD]); Cardio-Vascular (CV) outcomes (angina or myocardial infarction); Damage (SDI≥1); and Death. Time-independent and time-dependent Cox proportional hazards models were applied to describe the effect of CR, PR or NR on long-term outcomes.

Results Of 277 patients, 63.9% achieved CR, 18.41% PR, and 9.75% NR at 2 years. CR protected from all long-term outcomes compared to PR and NR on Kaplan-Meier analysis and Cox model (Figure 1). CR protected against CV outcomes only in the Cox model. Compared to NR, PR only protected against low eGFR. Neither CR nor PR protected against damage. On time-dependent analysis, when comparing CR to NR and PR to NR, only NR was a risk factor for ESRD when compared to CR (HR=3.93).

Abstract 219 Figure 1

Kaplan Meier analysis of long term outcome of low eGFR (<15 mL/min) among patients who acheived CR, PR or NR at 2 years of LN diagnosis

Conclusions CR protects against CV and renal outcomes, and mortality. PR protects against low eGFR.

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