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Abstract
Background Lupus nephritis (LN) has been identified as a major risk factor for the mortality in patients with systemic lupus erythematosus (SLE). We investigated the predictors of end-stage renal disease (ESRD) and death among LN patients.
Methods This study enrolled Korean patients with biopsy-proven LN, from a prospective BAE lupus cohort between January 1998 and December 2018. Baseline demographics, histological, and clinical features were collected, and the disease activity measured by the SLE Disease Activity Index 2000 (SLEDAI-2K) and organ damage determined by the Systemic Lupus International Collaborating Clinics Damage Index (SDI) score were annually assessed.
Results In total, 599 patients with proliferative LN (class III and IV/±V) and membranous LN (class V) were included and followed for a mean of 10.7 ± 6.7 years. 42 (7.0%) LN patients developed ESRD. In a multivariate logistic regression model, anti-phospholipid (aPL) antibodies [odds ratio (OR) 2.94, CI 1.1–7.87, p=0.032] and higher activity index score at renal biopsy [OR 1.12, CI 1.01–1.26, p=0.048] were independent predictors of ESRD after adjusting for age, sex, and disease duration (table 1). 31 patients died and the leading cause of death was SLE flare, followed by infection. Non-ESRD patients had better survival rate than ESRD patients in Kaplan-Meier analysis (p=0.03 in log-rank test, figure 1). Multivariate Cox regression indicated that a higher adjusted mean SLEDAI-2K (AMS) [hazard ratio (HR) 1.43, CI 1.3–1.58, p<0.001] and higher extra-renal AMS [HR 1.83, CI 1.48–2.25, p<0.001] were significantly associated with increased overall mortality.
Conclusions We identified key predictors of the worst long term outcome, ESRD and death, in patients with lupus nephritis, emphasizing the importance of strict disease activity control to prevent death in high-risk groups of ESRD progression.
Kaplan-Meier analysis with log-rank test to measure survival rate between ESRD and non-ESRD patients with lupus nephritis. X-axis displays the time in years, and Y-axis displays the patient survival rate. ESRD: end-stage-renal-disease. p< 0.05 is the threshold for significance
Baseline clinical characteristics and multivariate logistic analysis of variables associated with end-stage renal disease in 599 patients with lupus nephritis
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