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Long-term Outcomes of Lupus Nephritis in Comparison to Other CKD Etiologies
Charikleia Chrysostomou1,2, Francesca Faustini1, Iva Gunnarsson1
1Division of Rheumatology, Department of Medicine-Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Insights
Patients with lupus nephritis (LN)-CKD face higher risks of death and cardiovascular events compared to primary glomerular disease (PGD)-CKD. However, their risk of kidney replacement therapy (KRT) is lower, similar to other CKD causes.
Area of Science:
- Nephrology
- Cardiology
- Immunology
Background:
- Chronic kidney disease (CKD) encompasses various etiologies, each potentially impacting cardiovascular and kidney outcomes differently.
- Lupus nephritis (LN) is an autoimmune cause of CKD, but its long-term prognosis regarding cardiovascular events and kidney function decline relative to other CKD types is not well-established.
Purpose of the Study:
- To compare long-term cardiovascular and kidney outcomes between patients with LN-CKD and those with CKD from primary glomerular diseases (PGD) or other causes (Other-CKD).
Main Methods:
- A Swedish Renal Registry study (2006-2021) compared outcomes in LN-CKD (n=317) versus PGD-CKD (n=2296) and Other-CKD (n=34,778).
- Cox proportional hazard models were used to estimate adjusted hazard ratios (HRs) for mortality, major adverse cardiovascular events (MACE), and kidney replacement therapy (KRT).
Main Results:
- LN-CKD patients had intermediate absolute risks of death and MACE between Other-CKD and PGD-CKD groups.
- The 5-year KRT risk was similar for LN-CKD (22%) and Other-CKD, but lower than PGD-CKD (37%).
- Multivariable analysis showed LN-CKD had higher risks of death (HR: 1.63) and MACE (HR: 1.65) compared to PGD-CKD, but a similar risk of adverse events compared to Other-CKD.
Conclusions:
- Despite a lower KRT risk than PGD-CKD, LN-CKD patients exhibit increased mortality and MACE risks, comparable to patients with high cardiovascular burden (Other-CKD).
- Findings highlight the significant cardiovascular risk in LN-CKD and inform strategies for cardiovascular event prevention.
Introduction:
Little is known regarding the comparison of cardiovascular and kidney outcomes between lupus nephritis (LN) and other etiologies of chronic kidney disease (CKD).
Methods:
Using data from the Swedish Renal Registry (2006-2021), we compared long-term outcomes between patients with LN-CKD and patients with CKD due to primary glomerular diseases (PGD) and other CKD causes (Other-CKD, mainly diabetes and nephroangiosclerosis). Adjusted hazard ratios (HRs) of mortality, major adverse cardiovascular events (MACE) and kidney replacement therapy (KRT) were estimated using Cox proportional hazard models.
Results:
At baseline, LN (n = 317, 61 years, 76% women) and PGD (n = 2296, 57 years, 30% women) had better kidney function and lower prevalence of cardiovascular disease than the Other-CKD (n = 34,778, 75 years, 36% women). The median follow-up was 6.2 (3.3-9.8) years. The absolute risks of death and MACE in LN-CKD were intermediate between those of Other-CKD and PGD. The 5-year absolute KRT risk of LN-CKD was similar to Other-CKD's risk (22%) and lower than in PGD (37%). In multivariable analysis, as compared to PGD, the rates of death and MACE in LN-CKD were higher (HR: 1.63 [95% confidence interval: 1.32-2.02] and 1.65 [1.31-2.08]), whereas the rate of KRT tended to be lower (0.81 [0.64-1.02]). In contrast, the rate of adverse events was not different between LN-CKD and Other-CKD.
Conclusion:
Although patients with LN-CKD had a lower risk of KRT than PGD-CKD, they exhibited higher risk of death and MACE, reaching the risk magnitude of patients with high cardiovascular burden (Other-CKD). Our findings may inform decisions about prevention of cardiovascular events in patients with moderate and advanced LN-CKD.
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