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An epidemiologic analysis of end-stage lupus nephritis
1Third Department of Internal Medicine, University of The Ryukyus, Okinawa, Japan.
Insights
Systemic lupus erythematosus (SLE) patients show improved survival rates over time, with earlier diagnosis linked to better outcomes. However, male patients with SLE face significantly poorer renal survival compared to females.
Area of Science:
- Nephrology
- Rheumatology
- Epidemiology
Background:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with significant morbidity and mortality.
- Lupus nephritis, a severe complication of SLE, often leads to end-stage renal disease.
- Understanding long-term outcomes and risk factors is crucial for managing SLE patients.
Purpose of the Study:
- To analyze the incidence, prevalence, and survival trends of SLE in Okinawa, Japan.
- To identify factors affecting patient and renal survival in SLE patients.
- To assess the cumulative incidence of end-stage lupus nephritis over time.
Main Methods:
- Retrospective analysis of 566 SLE patients diagnosed between 1972 and 1991.
- Cox proportional hazard analysis to evaluate patient and renal survival.
- Calculation of annual incidence and prevalence rates stratified by sex.
Main Results:
- Annual incidence and prevalence of SLE increased significantly from 1972 to 1991, particularly in females.
- Patient survival rates improved over time, with earlier diagnosis correlating to better outcomes (HR 0.48 for 1987-1991 diagnoses).
- Male SLE patients exhibited significantly poorer renal survival (HR 3.64) compared to females. Cumulative 20-year incidence of end-stage lupus nephritis was 21.0%.
Conclusions:
- SLE patient survival has improved, likely due to advances in diagnosis and treatment.
- Male sex is a significant risk factor for poor renal survival in SLE.
- Long-term renal survival remains a concern, necessitating continued research and improved management strategies for lupus nephritis.
Abstract:
We analyzed 566 patients (515 females and 51 males) with systemic lupus erythematosus who were treated in Okinawa, Japan, from 1972 to 1991 and followed until April 1993. One hundred four patients (95 females and 9 males) died, and 51 were considered to have end-stage lupus nephritis. The annual incidence and prevalence, per million population in each sex, were increased from 16.0 and 66.0 in 1972 to 46.7 and 683.9 in 1991 in the female patients, and from 4.2 and 8.3 in 1973 to 8.3 and 70.0 in 1991 in the male patients, respectively. Cox proportional hazard analysis was done to determine the effects of several covariates on patients and renal survival. The patients' survival rate improved, as the hazard ratio (HR) was decreased to 0.69 (year of diagnosis, 1982 to 1986) and to 0.48 (year of diagnosis, 1987 to 1991) when the HR in patients diagnosed before 1981 was taken as 1.00. Similarly, we examined renal survival by using the Cox proportional model. For this analysis, the date of start of dialysis therapy was regarded as the time of renal death. Male patients had significantly poor renal survival; the HR was 3.64 (95% confidence interval, 1.89 to 6.98) when the HR in the females was taken as 1.00. However, age at diagnosis and year of diagnosis did not significantly affect renal survival. The cumulated incidence of end-stage lupus nephritis from the time of diagnosis of systemic lupus erythematosus was 3.1% at 5 years, 9.4% at 10 years, 15.5% at 15 years, and 21.0% at 20 years.(ABSTRACT TRUNCATED AT 250 WORDS)