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Challenges of Managing Lupus Nephritis in an Emerging Nephrology Centre: A Fijian Cohort Study
Vishal Kumar1, Yogeshni Chandra2, Sabiha Khan3
1Department of Internal Medicine, Colonial War Memorial Hospital, Suva, Fiji.
Insights
Fiji has a high incidence of Lupus Nephritis (LN), with nearly half of patients experiencing severe outcomes like death or dialysis dependence within two years. This highlights the urgent need for targeted healthcare strategies in the Pacific region.
Area of Science:
- Nephrology
- Epidemiology
- Immunology
Background:
- Lupus Nephritis (LN) is a severe complication of Systemic Lupus Erythematosus.
- Data on LN epidemiology and outcomes in Pacific Island nations is scarce.
- Understanding local disease burden is crucial for effective healthcare planning.
Purpose of the Study:
- To characterize the epidemiology and clinical outcomes of Lupus Nephritis (LN) in Fiji.
- To establish incidence rates and identify risk factors for poor outcomes in an underserved population.
Main Methods:
- Retrospective analysis of adult LN cases diagnosed between 2016-2020 at Fiji's national referral hospital.
- Data collection included patient demographics, ethnicity, kidney biopsy findings, treatment, and clinical outcomes (kidney failure, dialysis, death).
Main Results:
- A total of 33 adult LN cases were identified.
- The crude annual incidence was 2.44 per 100,000 population, with a median age of 25.7 years and a predominance of iTaukei ethnicity.
- At 2 years, 39% experienced kidney failure, 39% died, and suboptimal adherence to therapy was linked to increased risk of dialysis or death.
Conclusions:
- Fiji exhibits a high incidence of Lupus Nephritis with concerningly poor outcomes.
- Nearly half of the cohort faced death or dialysis dependence within two years of diagnosis.
- Findings underscore the need for enhanced, targeted healthcare strategies for LN in Fiji and other Pacific Island countries.
Aim:
To characterise the epidemiology and outcomes of Lupus Nephritis (LN) in Fiji.
Methods:
All adult LN cases diagnosed from 2016 to 2020 at the national referral hospital were included. Treatment response, kidney failure, dialysis dependence and death were reported.
Results:
From 33 cases, a crude annual incidence of 2.44 (95% CI 1.73-3.43) per 100,000 population and an age-standardised incidence of 2.37 (95% CI 0.65-4.09) per 100,000 population was derived. The median age was 25.7 years (IQR 19.5-32) with a predominance of indigenous iTaukei ethnicity (67%). Kidney biopsy with adequate tissue was performed in 24 patients (73%), revealing LN class III in 10 patients (42%) and class IV in 14 patients (58%). Twenty-eight patients (85%) underwent induction immunosuppression, with complete and partial response in 12 patients (43%) and 2 patients (7%) at 12 months, respectively. No factor was found to be significantly associated with complete response at 12 months. At 2 years, 13 patients (39%) had developed kidney failure, 6 of whom commenced dialysis, and 13 patients (39%) had died. The risk of dialysis dependence or death was associated with suboptimal adherence to therapy (OR 12.0, 95% CI 1.23-117, p = 0.028) and 12-month complete response (OR 0.08, 95% CI 0.01-0.54, p = 0.005).
Conclusion:
Fiji has a high incidence of LN and nearly half of our cohort had either died or were dialysis dependent within 2 years of diagnosis. These results will inform targeted healthcare strategies that can be implemented in Fiji and neighbouring Pacific Island countries.
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