Treatment of rheumatoid arthritis in patients with chronic kidney disease: A real-world experience

Rheumatoid arthritis is associated with an increased risk of chronic kidney disease, which complicates the safe use of disease-modifying antirheumatic drugs (DMARDs), particularly in patients with severe renal impairment. Our aim was to describe treatment patterns and clinical outcomes in this population.

Descriptive study of a cohort of RA patients with an estimated glomerular filtration rate (eGFR) <30 ml/min/1.73 m², managed in a comprehensive care program between 2022 to 2024. Clinical, therapeutic, and safety data were collected.

A total of 38 patients were identified, most of whom were elderly women with a high burden of comorbidities. Leflunomide was the most frequently used conventional synthetic DMARD. Biologic therapy was used in 42% of cases, with rituximab being the most commonly prescribed agent. Most patients achieved remission or low disease activity, with no serious adverse events reported.

These findings provide real-world evidence on the effectiveness and safety of DMARDs in a population often excluded from clinical trials, underscoring the need for prospective studies to inform long-term therapeutic decisions.