Factors predictive of long-term mortality in lupus nephritis: a multicenter retrospective study of a Japanese cohort
K Ichinose1, M Kitamura2, S Sato3
11 Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Insights
Achieving complete renal response (CR) in lupus nephritis (LN) within 12 months of treatment significantly improves patient survival. Male gender and higher disease activity predict a failure to achieve CR.
Area of Science:
- Nephrology
- Rheumatology
- Clinical Medicine
Background:
- Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus (SLE), significantly impacting patient mortality.
- Evaluating the link between achieving complete renal response (CR) and long-term survival in LN patients is crucial for treatment optimization.
Purpose of the Study:
- To assess the association between achieving CR at 6 and 12 months post-induction therapy and overall survival in lupus nephritis patients.
- To identify predictive factors for achieving CR and their correlation with mortality in LN.
Main Methods:
- Retrospective analysis of 172 LN patients who underwent renal biopsy between 1990-2016.
- CR rates at 6 and 12 months were determined; predictive factors for CR and survival were analyzed using regression and Kaplan-Meier methods.
Main Results:
- The 20-year survival rate was 85.4%, with 5.2% of patients dying from various causes.
- Predictors of CR at 6 months included male gender, proteinuria, and index of activity; at 12 months, male gender and index of activity were significant.
- Achieving CR at 12 months strongly correlated with improved survival rates (OR 0.18, p=0.0339).
Conclusions:
- Achievement of CR at 12 months post-induction therapy is a significant predictor of improved survival in lupus nephritis.
- Male gender and a higher index of activity are identified as common factors predicting the failure to achieve CR at both 6 and 12 months.
Background:
Lupus nephritis (LN) is a major determinant of mortality in systemic lupus erythematosus (SLE). Here we evaluated the association between complete renal response (CR) and mortality in LN.
Methods:
We retrospectively analyzed the cases of 172 of 201 patients with LN for whom data on the therapeutic response at 6 and 12 months after induction therapy were available. The patients underwent a renal biopsy at Nagasaki University Hospital and community hospitals in Nagasaki between the years 1990 and 2016. We determined the CR rates at 6 and 12 months after induction therapy initiation and evaluated the predictive factors for CR and their relationship with mortality. We performed univariate and multivariable competing risks regression analyses to determine the factors predictive of CR. The patients' survival data were analyzed by the Kaplan-Meier method with a log-rank test.
Results:
The median follow-up duration after renal biopsy was 120 months (interquartile range: 60.3-191.8 months). The 5-, 10-, 15- and 20-year survival rates of our cohort were 99.3, 94.6, 92.0 and 85.4%, respectively. During follow-up, nine patients (5.2%) died from cardiovascular events, infection, malignancy and other causes. The multivariate analysis revealed that the following factors were predictive of CR. At 6 months: male gender (odds ratio (OR) 0.23, 95% confidence interval (CI) 0.08-0.65, p = 0.0028), proteinuria (g/gCr) (OR 0.83, 95% CI 0.71-0.97, p = 0.0098) and index of activity (0-24) (OR 0.84, 95% CI 0.71-0.99, p = 0.0382). At 12 months: male gender (OR 0.25, 95% CI 0.09-0.67, p = 0.0043) and index of activity (0-24) (OR 0.82, 95% CI 0.69-0.98, p = 0.0236). The Kaplan-Meier analysis showed that compared to not achieving CR at 12 months, achieving CR at 12 months was significantly correlated with the survival rate (OR 0.18, 95% CI 0.04-0.92, p = 0.0339).
Conclusions:
Our results suggest that the survival rate of patients with LN is associated with the achievement of CR at 12 months after induction therapy, and that male gender and a higher index of activity (0-24) are the common predictive factors for failure to achieve CR at 6 and 12 months.
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