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Prevalence of CKD in Patients With LN and SLE Ranges From 10% to Almost 50%, Review Finds
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Key Takeaways
- CKD prevalence in LN patients ranges from below 10% to nearly 50%, with ESKD rates from 1.2% to 24.8%.
- Risk factors for CKD include male gender, low hematocrit, severe renal impairment, hypertension, and proteinuria.
Some risk factors for chronic kidney disease (CKD) in patients with lupus nephritis (LN) and systemic lupus erythematosus (SLE) were renal impairment, delayed diagnosis, and hypertension.
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The prevention of end stage kidney disease (ESKD) is a significant goal when helping patients manage their lupus nephritis (LN). Additionally, chronic kidney disease (CKD) of variable severity is commonly shown in these patients; however, recent research has limited data on CKD when treating patients with acute LN. In a review published in Nephrology, investigators assessed the prevalence of risk factors of CKD in patients with LN. Additionally, they discussed the management and knowledge gaps that are present in the underrecognized phase that predates ESKD.
For this research, the investigators performed a scoping review to map the available evidence of diverse real-world cohorts of patients with LN and systemic lupus erythematosus (SLE) with longitudinal follow-up. Articles were eligible for inclusion if they explored the relationship between LN and CKD in terms of prevalence and risk factors. Additionally, they included the following: defined CKD as an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2 (as per the Kidney Disease: Improving Global Outcomes guidelines); or CKD progression as a decrease in eGFR of at least 30% or doubling of serum creatinine.
Further, the investigators carried out a narrative synthesis to provide an overview of the prevalence and risk factors of CKD in real-world cohorts to discuss areas for intervention, relevance to current practice guidelines, and areas that should be addressed in future research. A total of 15 retrospective cohort studies were included in the final review, according to the authors. Only 3 were SLE cohorts which included patients with LN, whereas the rest were LN only cohorts of which most patients had biopsy-proven LN. Follow-ups ranged from 3 to 14 years across the studies.
The findings showed that prevalence rates of CKD or CKD progression in patients with LN and SLE ranged from below 10% and approaching 50%. Additionally, the prevalence of ESKD ranged from approximately 1.2% to 24.8%. Further, in patients with LN, CKD prevalence ranged from approximately 14.6% to 23.7%, and was primarily observed in White populations, whereas studies in Asia, Israel, and Brazil had non-White populations with CKD prevalence rates ranging from 20.5% to 47.6%. In SLE cohorts, patients with LN had a 3- to 6-fold increased risk of developing CKD. These patients also demonstrated worse long-term renal survival (65.5%, 54.5%, 43.8% vs 87.5%, 80.3%, 72.7% at 5, 10, and 15 years, respectively) and more rapid eGFR decline (−4.35 vs −0.66 mL/min/year, p < .05) compared with those who did not have LN.
Further, risk factors that were associated with CKD development or progression included being male, low hematocrit, LN during disease course, older age, among others. Clinical characteristics that were deemed risk factors in multiple studies consisted of the following: severe renal impairment at baseline (expressed as lower eGFR, higher creatinine levels, or proportion of patients with eGFR < 60 mL/min/1.73 m2); presence of hypertension at baseline; higher levels of proteinuria (described as higher time-averaged proteinuria, 24-hour urine protein of > 0.9 g/day, and proteinuria of > 0.8 g/day at 12 months); failure to achieve remission; and the occurrence of nephritic flares. Histological features identified as risk factors include higher tubular atrophy score, interstitial fibrosis and tubular atrophy score of more than 25%, tubulointerstitial involvement, and total cortical inflammation.
The authors acknowledge that biases and unrecognized confounders are limitations, as with other retrospective studies. CKD progression and ESKD continue to be influences on adverse patient outcomes and overall quality of life. Identifying these risk factors can serve as a foundation for the development of intervention methods. Further, the authors emphasize that a knowledge gap on the impact of treatments on CKD progression remains, which must be evaluated in future research.
