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Long-term Outcomes of Lupus Nephritis in Comparison to Other CKD Etiologies

Chrysostomou, Charikleia ; Faustini, Francesca ; Gunnarsson, Iva ; Segelmark, Mårten LU orcid ; Carrero, Juan Jesús ; Barany, Peter ; Faucon, Anne Laure and Evans, Marie (2025) In Kidney International Reports 10(1). p.157-168
Abstract

Introduction: Little is known regarding the comparison of cardiovascular and kidney outcomes between lupus nephritis (LN) and other etiologies of chronic kidney disease (CKD). Methods: Using data from the Swedish Renal Registry (2006–2021), we compared long-term outcomes between patients with LN-CKD and patients with CKD due to primary glomerular diseases (PGD) and other CKD causes (Other-CKD, mainly diabetes and nephroangiosclerosis). Adjusted hazard ratios (HRs) of mortality, major adverse cardiovascular events (MACE) and kidney replacement therapy (KRT) were estimated using Cox proportional hazard models. Results: At baseline, LN (n = 317, 61 years, 76% women) and PGD (n = 2296, 57 years, 30% women) had better kidney function and... (More)

Introduction: Little is known regarding the comparison of cardiovascular and kidney outcomes between lupus nephritis (LN) and other etiologies of chronic kidney disease (CKD). Methods: Using data from the Swedish Renal Registry (2006–2021), we compared long-term outcomes between patients with LN-CKD and patients with CKD due to primary glomerular diseases (PGD) and other CKD causes (Other-CKD, mainly diabetes and nephroangiosclerosis). Adjusted hazard ratios (HRs) of mortality, major adverse cardiovascular events (MACE) and kidney replacement therapy (KRT) were estimated using Cox proportional hazard models. Results: At baseline, LN (n = 317, 61 years, 76% women) and PGD (n = 2296, 57 years, 30% women) had better kidney function and lower prevalence of cardiovascular disease than the Other-CKD (n = 34,778, 75 years, 36% women). The median follow-up was 6.2 (3.3–9.8) years. The absolute risks of death and MACE in LN-CKD were intermediate between those of Other-CKD and PGD. The 5-year absolute KRT risk of LN-CKD was similar to Other-CKD's risk (22%) and lower than in PGD (37%). In multivariable analysis, as compared to PGD, the rates of death and MACE in LN-CKD were higher (HR: 1.63 [95% confidence interval: 1.32–2.02] and 1.65 [1.31–2.08]), whereas the rate of KRT tended to be lower (0.81 [0.64–1.02]). In contrast, the rate of adverse events was not different between LN-CKD and Other-CKD. Conclusion: Although patients with LN-CKD had a lower risk of KRT than PGD-CKD, they exhibited higher risk of death and MACE, reaching the risk magnitude of patients with high cardiovascular burden (Other-CKD). Our findings may inform decisions about prevention of cardiovascular events in patients with moderate and advanced LN-CKD.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
cardiovascular event, chronic kidney disease, kidney replacement therapy, lupus nephritis, mortality, primary glomerular disease
in
Kidney International Reports
volume
10
issue
1
pages
12 pages
publisher
Elsevier
external identifiers
  • pmid:39810755
  • scopus:85208922922
ISSN
2468-0249
DOI
10.1016/j.ekir.2024.10.021
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2024 International Society of Nephrology
id
70fcb555-65b4-495e-ae1f-80a052a1a541
date added to LUP
2025-01-23 11:42:58
date last changed
2025-07-11 12:44:21
@article{70fcb555-65b4-495e-ae1f-80a052a1a541,
  abstract     = {{<p>Introduction: Little is known regarding the comparison of cardiovascular and kidney outcomes between lupus nephritis (LN) and other etiologies of chronic kidney disease (CKD). Methods: Using data from the Swedish Renal Registry (2006–2021), we compared long-term outcomes between patients with LN-CKD and patients with CKD due to primary glomerular diseases (PGD) and other CKD causes (Other-CKD, mainly diabetes and nephroangiosclerosis). Adjusted hazard ratios (HRs) of mortality, major adverse cardiovascular events (MACE) and kidney replacement therapy (KRT) were estimated using Cox proportional hazard models. Results: At baseline, LN (n = 317, 61 years, 76% women) and PGD (n = 2296, 57 years, 30% women) had better kidney function and lower prevalence of cardiovascular disease than the Other-CKD (n = 34,778, 75 years, 36% women). The median follow-up was 6.2 (3.3–9.8) years. The absolute risks of death and MACE in LN-CKD were intermediate between those of Other-CKD and PGD. The 5-year absolute KRT risk of LN-CKD was similar to Other-CKD's risk (22%) and lower than in PGD (37%). In multivariable analysis, as compared to PGD, the rates of death and MACE in LN-CKD were higher (HR: 1.63 [95% confidence interval: 1.32–2.02] and 1.65 [1.31–2.08]), whereas the rate of KRT tended to be lower (0.81 [0.64–1.02]). In contrast, the rate of adverse events was not different between LN-CKD and Other-CKD. Conclusion: Although patients with LN-CKD had a lower risk of KRT than PGD-CKD, they exhibited higher risk of death and MACE, reaching the risk magnitude of patients with high cardiovascular burden (Other-CKD). Our findings may inform decisions about prevention of cardiovascular events in patients with moderate and advanced LN-CKD.</p>}},
  author       = {{Chrysostomou, Charikleia and Faustini, Francesca and Gunnarsson, Iva and Segelmark, Mårten and Carrero, Juan Jesús and Barany, Peter and Faucon, Anne Laure and Evans, Marie}},
  issn         = {{2468-0249}},
  keywords     = {{cardiovascular event; chronic kidney disease; kidney replacement therapy; lupus nephritis; mortality; primary glomerular disease}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{157--168}},
  publisher    = {{Elsevier}},
  series       = {{Kidney International Reports}},
  title        = {{Long-term Outcomes of Lupus Nephritis in Comparison to Other CKD Etiologies}},
  url          = {{http://dx.doi.org/10.1016/j.ekir.2024.10.021}},
  doi          = {{10.1016/j.ekir.2024.10.021}},
  volume       = {{10}},
  year         = {{2025}},
}