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Published on: June 8, 2022
Predictors of chronic kidney disease in Korean patients with lupus nephritis
Su-Jin Moon1, Seung-Ki Kwok, Ji Hyeon Ju
1Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul, South Korea.
Insights
Predicting chronic kidney disease (CKD) in lupus nephritis (LN) is crucial. Key predictors include delayed onset, reduced eGFR at diagnosis, and failure to maintain remission in Korean patients.
Area of Science:
- Nephrology
- Immunology
- Internal Medicine
Background:
- Chronic kidney disease (CKD) significantly increases mortality and end-stage renal disease risk.
- Lupus nephritis (LN) is a common cause of CKD, necessitating identification of progression risk factors.
Purpose of the Study:
- To identify independent risk factors for the development of CKD in Korean patients with LN.
- To improve prediction models for progressive kidney disease in LN.
Main Methods:
- Retrospective analysis of 322 Korean LN patients diagnosed between 1985 and 2010.
- Kaplan-Meier methods for risk assessment and Cox proportional hazards regression for factor identification.
Main Results:
- CKD developed in 22% of patients within 10 years of LN diagnosis.
- Significant predictors included delayed LN onset (HR 2.904), low eGFR at LN onset (HR 7.458), LN relapse (HR 2.806), and resistance to therapy (HR 8.120).
Conclusions:
- Delayed-onset LN, decreased eGFR at LN onset, and failure to achieve sustained remission predict CKD development.
- These factors are critical for risk stratification and management of LN patients.
Objective:
Since chronic kidney disease (CKD) is closely associated with cardiovascular disease and mortality as well as endstage renal disease, prediction of progressive CKD is a clinically important issue. We investigated the independent risk factors for the development of CKD in patients with lupus nephritis (LN).
Methods:
The cohort included 322 Korean patients diagnosed with LN between 1985 and 2010. We retrospectively analyzed the clinical and laboratory indices, treatment response, the final renal function, and the biopsy findings. The timing and cumulative risk of developing CKD were identified by Kaplan-Meier methods. The independent risk factors for developing CKD were examined by univariate and multivariate Cox proportional hazards regression analyses.
Results:
The median followup time after the diagnosis of LN was 84 months. CKD occurs in 22% of the patients within 10 years after the diagnosis of LN. The probability of developing CKD was significantly associated with the onset time of LN (delayed-onset LN vs initial-onset LN; HR 2.904, p = 0.003), deteriorated renal function [an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m(2) body surface area] at the onset of LN (HR 7.458, p < 0.001), relapse of LN after achieving remission (HR 2.806, p = 0.029), and resistance to induction therapy (HR 8.120, p < 0.001).
Conclusion:
Our results demonstrate that delayed-onset LN, a decreased eGFR at the time of LN onset, and the failure to achieve a sustained remission are predictors for the development of CKD in Korean patients with LN.
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