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O44 Long-term outcomes of chronic kidney disease patients with lupus nephritis: a nationwide cohort study
  1. Charikleia Chrysostomou1,
  2. Anne-Laure Faucon2,3,
  3. Francesca Faustini1,
  4. Iva Gunnarsson1,
  5. Peter Barany4 and
  6. Marie Evans4
  1. 1Dept. of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
  2. 2Dept. of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  3. 3Dept. of Clinical Epidemiology, Centre for Research in Epidemiology and Population Health, Inserm U1018, Paris-Saclay University, France
  4. 4Dept. of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden

Abstract

Objective To explore the long-term outcomes of patients with chronic kidney disease (CKD) due to Lupus Nephritis (LN), as compared to CKD of other etiologies.

Methods Using data extracted from the Swedish Renal Registry (2006–2021), we compared clinical outcomes between: 1) CKD related to LN (LN-CKD); 2) CKD related to primary glomerular diseases [PGD-CKD, i.e. IgA nephropathy, focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MN)]; 3) CKD related to other causes (Other-CKD, mostly diabetes and nephrosclerosis). Cox proportional hazard models were used to estimate adjusted hazard ratios of mortality, major cardiovascular events (MACE) and kidney replacement therapy (KRT).

Results At baseline, LN-CKD (N=317, 61 years, 76% females, mean eGFR 38.7 mL/min per 1.73 m2) and PGD-CKD (N=2296, 57 years, 69% males, mean eGFR 36.5 mL/min per 1.73 m2) had a lower prevalence of cardiovascular disease than the Other-CKD (N=34778, 75 years, 64% males, mean eGFR 26.5 mL/min per 1.73 m2).

Over a median follow-up of 6.2 [3.3;9.8] years, 19029 deaths (51%), 15768 (42%) MACE and 8390 (22%) KRT events occurred. The unadjusted 5-year- absolute risks of death and MACE were high both in LN-CKD (27% and 25%) and Other-CKD (50% and 44%), but lower in PGD-CKD (16% and 14%), whereas the 5-year- risk for KRT was higher in PGD (PGD-CKD: 37%, LN-CKD: 23%, Other-CKD: 23%).

In the multivariable analyses, as compared to PGD-CKD, the risks of death and MACE were higher in patients with LN-CKD (HR: 1.63 [95%CI: 1.32–2.02] for death, HR: 1.65 [1.31–2.08] for MACE) and Other-CKD (HR: 1.67 [1.52–1.84] for death, HR: 1.76 [1.58–1.96] for MACE). In contrast, the risk for KRT was lower both in patients with LN-CKD (HR: 0.81 [0.64–1.02] although 95%CI slightly overlaps) and in the Other-CKD group (HR: 0.84 [0.78–0.91]) (figure 1).

Abstract O44 Figure 1
Abstract O44 Figure 1

Conclusion While LN-CKD had a lower risk for KRT than PGD-CKD, exhibited higher risk for MACE and death, reaching the risk magnitude of older patients with high cardiovascular burden (Other-CKD). This highlights the need for cardiovascular prevention in LN, especially in moderate to advanced CKD.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/lupus-2024-el.53

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