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Advanced Chronic Kidney Disease in Lupus Nephritis: Is Dialysis Inevitable?

Konstantinos Tselios1,2, Dafna D Gladman1,2, Jiandong Su1,2

  • 1From the Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, Ontario, Canada.

The Journal of Rheumatology
|April 3, 2020
PubMed

Insights

Progression to dialysis is not inevitable for advanced lupus nephritis (LN) chronic kidney disease (CKD). Active disease markers and increased prednisone predict decline, while renin-angiotensin system blockers may offer protection.

Area of Science:

  • Nephrology
  • Immunology
  • Internal Medicine

Background:

  • Advanced chronic kidney disease (CKD) significantly increases the risk of end-stage renal disease (ESRD).
  • Lupus nephritis (LN) is a common cause of CKD, necessitating understanding of its progression factors.

Purpose of the Study:

  • To determine the rate of renal function decline in patients with advanced CKD due to LN.
  • To identify key factors influencing the progression of CKD in lupus nephritis patients.

Main Methods:

  • A longitudinal cohort study identified 118 patients with advanced CKD (stage 3b or 4) related to LN.
  • Patients were monitored for progression to ESRD, with demographic, clinical, immunological, and therapeutic data analyzed.
  • Multivariable Cox regression models identified predictors of renal function decline.

Main Results:

  • Forty-five patients (38%) progressed over an average of 6 years; 29 reached ESRD.
  • Active serology (high anti-dsDNA, low C3/C4) and increased prednisone dosage were linked to progression.
  • Renin-angiotensin system (RAS) blocker use was associated with a reduced risk of progression.

Conclusions:

  • Dialysis is not an inevitable outcome for all patients with advanced LN-related CKD, as 62% did not progress over 10 years.
  • Predictors for progression to ESRD were identified, including active immunological markers and corticosteroid management.
  • Understanding these factors can guide therapeutic strategies to preserve renal function in LN patients.
Abstract

Keywords:
ADVANCED KIDNEY DISEASELUPUS NEPHRITISPROGRESSION

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