Cardiometabolic Risk, Evaluation, and Control in Lupus Nephritis

Lupus nephritis (LN) is associated with atherosclerotic cardiovascular disease but early recognition of cardiometabolic risk in patients with LN can facilitate risk optimization with disease-modifying strategies. To identify potential gaps in cardiometabolic risk management in LN in real-world practice, we aimed to evaluate the prevalence and trend in cardiometabolic risk, evaluation, and control.

We performed a single-center, cross-sectional study of all adults with biopsy-confirmed LN between 2011 and 2022 to (1) assess the prevalence of cardiometabolic risks (age, sex, diabetes mellitus, hypertension, hyperlipidemia, ischemic heart disease [IHD], reduced kidney function [estimated glomerular filtration rate, estimated glomerular filtration rate <60 mL/min/1.73 m²], urine protein-to-creatinine ratio [UPCR] >0.15 g/g, glucocorticoid use), evaluation (office blood pressure [BP], fasting glucose and lipid and HbA1c), and control at the time of diagnosis; and then (2) evaluate the association between time periods (2019-2022 compared to 2015-2018) and cardiometabolic evaluation and control, adjusting for traditional and systemic lupus erythematosus disease-specific cardiometabolic risks in multivariable logistic regression models.

We evaluated 326 adults with LN (median age 42.0 years [interquartile range: 30.9, 52.7]). Across the 3 time periods, reduced kidney function was most frequent in 2011-2014. Hypertension and renin-angiotensin system blocker use were lowest in 2019-2022 (23.4% and 30.9%, respectively), while 38.0% achieved BP <130/80 mm Hg without significant change across time periods. Glycemic evaluation was least frequent in 2019-2022 (78.7%) compared to earlier time periods. Achievement of glycemic targets of fasting glucose <6.1 mmol/L and HbA1c ≤7% were 70.0% and 95.1%, respectively, without significant change across the time periods. Lipid evaluation was performed in 75.8% but only 32.0% achieved low-density lipoprotein-cholesterol <2.6 mmol/L. There was no significant change in the prevalence of lipid evaluation or control over time.

Glycemic assessment and optimization of BP and lipid treatment to achieve guideline-recommended targets represent opportunities to improve cardiometabolic risk management in LN.