Kidney function decline is an independent predictor of mortality among patients with lupus nephritis (LN), a new study finds.
Seung-Ki Kwok, MD, of Seoul St Mary’s Hospital, The Catholic University of Korea, and colleagues examined data from 401 Korean patients diagnosed with LN from 1985 to 2019, including 53 who died during 131 months of follow-up. In a univariate Cox hazards proportional analysis, hemoglobin levels less than 10 mg/dL and estimated glomerular filtration rate (eGFR) both at baseline and during follow-up significantly predicted early mortality. Treatment resistance at 6 and 12 months, delayed remission, and final renal response also were significant risk factors for mortality.
On multivariate analysis, only final kidney function in the range of chronic kidney disease stage 4 remained an independent predictor of mortality. It was significantly associated with a 5.8-fold increased risk for early death, Dr Kwok’s team reported in Lupus. The top causes of death in the LN cohort were infection, lupus flare, cardiovascular disease, and malignancy. No unexpected deaths occurred among the subset of patients who underwent kidney transplantation.
Overall mortality rates were 6.8%, 10.3%, 19.7%, and 28.0% at 5, 10, 20, and 30 years, respectively.
According to Dr Kwok and colleagues, “our study identified that renal function deterioration was the independent risk factor for mortality in Korean patients with LN. Therefore, regardless of the short-term renal response, we must treat patients aggressively and persistently to prevent renal function deterioration. We found that SLE flare also resulted in mortality of patients with LN who needed maintenance dialysis, suggesting the benefit of [kidney transplantation] on lupus activity and survival.”
Jeon H, Lee J, Hyeon Ju J, et al. Renal function deterioration is an independent mortality determinant in Koreans diagnosed with lupus nephritis. Lupus. 30(12):18961905. Published online November 23, 2021. doi:10.1177/09612033211038823