Background and aims End-stage renal disease (ESRD) is a major cause of morbidity and mortality in systemic lupus erythematosus (SLE). We studied the risk factors for development of ESRD among Filipino patients with lupus nephritis.
Methods Included were ESRD patients entered in the SLE database of University of Santo Tomas (UST) Hospital, Manila, Philippines from 2005 to 2015. The control group consisted of lupus nephritis patients without ESRD from same database – matched for age, gender and disease duration. Associations of risk factors including comorbidities and treatment for ESRD were tested using Cox-proportional hazard model.
Results Cases included 71 ESRD patients (58, 81.7% females, 50, 70% adults). Mean age at SLE diagnosis was 25.1±9.6 (7–47) years, mean SLE disease duration 9.5±5.5 (1–29) years, and mean disease duration from SLE diagnosis to ESRD 5.0±3.0 (0.5–14) years. By multivariate analysis, hypertension [hazard ratio (HR) 3.754; 95% CI 2.230, 6.320; p<0.001], and diabetes mellitus (HR 3.775; 95% CI 1.691, 8.425; p<0.001) prior to SLE diagnosis were independently associated with progression to ESRD. Onset and treatment of nephritis, and antiphospholipid antibody syndrome (APS) did not significantly impact progression to ESRD. Patients with both hypertension and APS had the shortest disease duration prior to ESRD, but this did not achieve statistical significance.
Conclusions We showed that hypertension and diabetes mellitus prior to SLE diagnosis were strongly associated with progression to ESRD in SLE, reinforcing need to recognise and aggressively control these co-morbidities early at SLE diagnosis, including minimal use of aggravating factors like corticosteroids.
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