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Lupus. 2019 Dec;28(14):1669-1677. doi: 10.1177/0961203319887799. Epub 2019 Nov 13.

Longitudinal associations of active renal disease with irreversible organ damage accrual in systemic lupus erythematosus.

Author information

1
School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.
2
Department of Nephrology, Monash Health, Clayton, Australia.
3
Chiang Mai University, Chiang Mai, Thailand.
4
Chang Gung Memorial Hospital, Taipei and Keelung, Taiwan.
5
National University Hospital, Singapore.
6
University of Malaya, Kuala Lumpur, Malaysia.
7
University of Santo Tomas Hospital, Manila, Philippines.
8
University of Padjadjaran, Bandung, Indonesia.
9
Tokyo Women's Medical University, Japan.
10
Tan Tock Seng Hospital, Singapore.
11
Rheumatology Liverpool Hospital, SWS Clinical School, UNSW and the Ingham Institute for Applied Medical Research, Sydney, Australia.
12
Royal Adelaide Hospital, Adelaide, Australia.
13
Flinders Medical Centre, Adelaide, Australia.
14
The University of Hong Kong, Hong Kong.
15
St. Vincent's Hospital, Melbourne, Australia.

Abstract

OBJECTIVE:

To examine longitudinal associations of active lupus nephritis with organ damage accrual in patients with systemic lupus erythematosus (SLE).

METHODS:

This study was performed using data from a large multinational prospective cohort. Active lupus nephritis at any visit was defined by the presence of urinary casts, proteinuria, haematuria or pyuria, as indicated by the cut-offs in the SLE Disease Activity Index (SLEDAI)-2K, collected at each visit. Organ damage accrual was defined as a change of SLICC-ACR Damage Index (SDI) score >0 units between baseline and final annual visits. Renal damage accrual was defined if there was new damage recorded in renal SDI domains (estimated glomerular filtration rate <50%/proteinuria >3.5 g per 24 h/end-stage kidney disease). Time-dependent hazard regression analyses were used to examine the associations between active lupus nephritis and damage accrual.

RESULTS:

Patients (N = 1735) were studied during 12,717 visits for a median (inter-quartile range) follow-up period of 795 (532, 1087) days. Forty per cent of patients had evidence of active lupus nephritis at least once during the study period, and active lupus nephritis was observed in 3030 (24%) visits. Forty-eight per cent of patients had organ damage at baseline and 14% accrued organ damage. Patients with active lupus nephritis were 52% more likely to accrue any organ damage compared with those without active lupus nephritis (adjusted hazard ratio = 1.52 (95% confidence interval (CI): 1.16, 1.97), p < 0.02). Active lupus nephritis was strongly associated with damage accrual in renal but not in non-renal organ domains (hazard ratios = 13.0 (95% CI: 6.58, 25.5) p < 0.001 and 0.96 (95% CI: 0.69, 1.32) p = 0.8, respectively). There was no effect of ethnicity on renal damage accrual, but Asian ethnicity was significantly associated with reduced non-renal damage accrual.

CONCLUSION:

Active lupus nephritis measured using the SLEDAI-2K domain cut-offs is associated with renal, but not non-renal, damage accrual in SLE.

KEYWORDS:

Lupus nephritis; organ damage accrual

PMID:
31718467
DOI:
10.1177/0961203319887799

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