Immunosuppression Does Not Prevent CKD in Patients With Lupus Nephritis
An analysis of 10-year follow-up data showed that immunosuppression may not be enough to prevent chronic kidney disease (CKD) in patients with lupus nephritis.
Both CKD and lupus are risk factors for cardiovascular disease, although most studies of long-term renal outcomes in patients with lupus nephritis focus on end-stage kidney disease (ESKD) instead of CKD. To remedy this research gap, the investigators conducted a retrospective chart review to examine the development of CKD in a subset of patients with biopsy-proven lupus nephritis who had been followed up for at least 10 years at a single-center, lupus nephritis clinic.
CKD was distinguished by an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/m2 and ESKD by an eGFR of less than 15 mL/min/1.73 m2 or the need for permanent kidney replacement therapy. The researchers adjusted eGFR by race and analyzed the results by using descriptive statistics.
The study followed up 72 patients for a median of 17 years after confirmation of lupus nephritis by kidney biopsy. Mean age of the group at biopsy was 32 years; 47 patients were White, 21 patients were Black, and 4 were Asian.
After a median of 15 years, ESKD had developed in 12 patients (17%). At the last follow-up visit, 27 patients (38%) had CKD, and their mean eGFR was 40 mL/min/1.73 m2.
Of the 27 patients in whom CKD had developed, 21 (78%) had at least one episode that lasted at least 6 months, during which their eGFR was less than 50 mL/min/1.73 m2. Of the other 6 patients with CKD, 4 (67%) had at least one episode of proteinuria (> 3.5 g/d) that lasted at least 6 months.
According to the researchers, this data suggests that more than half of patients with lupus nephritis may be at risk for ESKD or CKD within 10 years. “Immuno-suppression may not be sufficient to prevent CKD in [patients with lupus nephritis],” the researchers wrote. “These patients may benefit from intense anti‑progression therapy.”
Ayoub I, Wolf B, Tsao B, Oates J, Rovin BH. Kidney function in patients with lupus nephritis followed up for a very long time. Paper presented at: American Society of Nephrology Kidney Week 2021; November 4-7, 2021; Virtual. https://www.asn-online.org/education/kidneyweek/2021/program-abstract.aspx?controlId=361015