TY - JOUR
T1 - The frequency and outcome of lupus nephritis
T2 - results from an international inception cohort study
AU - Hanly, John G.
AU - O'Keeffe, Aidan G.
AU - Su, Li
AU - Urowitz, Murray B.
AU - Romero-Diaz, Juanita
AU - Gordon, Caroline
AU - Bae, Sang-Cheol
AU - Bernatsky, Sasha
AU - Clarke, Ann E.
AU - Wallace, Daniel J.
AU - Merrill, Joan T.
AU - Isenberg, David A.
AU - Rahman, Anisur
AU - Ginzler, Ellen M.
AU - Fortin, Paul
AU - Gladman, Dafna D.
AU - Sanchez-Guerrero, Jorge
AU - Petri, Michelle
AU - Bruce, Ian N.
AU - Dooley, Mary Anne
AU - Ramsey-Goldman, Rosalind
AU - Aranow, Cynthia
AU - Alarcón, Graciela S
AU - Fessler, Barri J.
AU - Steinsson, Kristjan
AU - Nived, Ola
AU - Sturfelt, Gunnar K.
AU - Manzi, Susan
AU - Khamashta, Munther A.
AU - van Vollenhoven, Ronald F
AU - Zoma, Asad A.
AU - Ramos-Casals, Manuel
AU - Ruiz-Irastorza, Guillermo
AU - Lim, S. Sam
AU - Stoll, Thomas
AU - Inanc, Murat
AU - Kalunian, Kenneth C.
AU - Kamen, Diane L.
AU - Maddison, Peter
AU - Peschken, Christine A.
AU - Jacobsen, Soren
AU - Askanase, Anca
AU - Theriault, Chris
AU - Thompson, Kara
AU - Farewell, Vernon
PY - 2016/2
Y1 - 2016/2
N2 - OBJECTIVE: To determine nephritis outcomes in a prospective multi-ethnic/racial SLE inception cohort.METHODS: Patients in the Systemic Lupus International Collaborating Clinics inception cohort (≤15 months of SLE diagnosis) were assessed annually for estimated glomerular filtration rate (eGFR), proteinuria and end-stage renal disease (ESRD). Health-related quality of life was measured by the Short Form (36 questions) health survey questionnaire (SF-36) subscales, mental and physical component summary scores.RESULTS: There were 1827 patients, 89% females, mean (s.d.) age 35.1 (13.3) years. The mean (s.d.) SLE duration at enrolment was 0.5 (0.3) years and follow-up 4.6 (3.4) years. LN occurred in 700 (38.3%) patients: 566/700 (80.9%) at enrolment and 134/700 (19.1%) during follow-up. Patients with nephritis were younger, more frequently men and of African, Asian and Hispanic race/ethnicity. The estimated overall 10-year incidence of ESRD was 4.3% (95% CI: 2.8%, 5.8%), and with nephritis was 10.1% (95% CI: 6.6%, 13.6%). Patients with nephritis had a higher risk of death (HR = 2.98, 95% CI: 1.48, 5.99; P = 0.002) and those with eGFR <30 ml/min at diagnosis had lower SF-36 physical component summary scores (P < 0.01) and lower Physical function, Physical role and Bodily pain scores. Over time, patients with abnormal eGFR and proteinuria had lower SF-36 mental component summary (P ≤ 0.02) scores compared to patients with normal values.CONCLUSION: LN occurred in 38.3% of SLE patients, frequently as the initial presentation, in a large multi-ethnic inception cohort. Despite current standard of care, nephritis was associated with ESRD and death, and renal insufficiency was linked to lower health-related quality of life. Further advances are required for the optimal treatment of LN.
AB - OBJECTIVE: To determine nephritis outcomes in a prospective multi-ethnic/racial SLE inception cohort.METHODS: Patients in the Systemic Lupus International Collaborating Clinics inception cohort (≤15 months of SLE diagnosis) were assessed annually for estimated glomerular filtration rate (eGFR), proteinuria and end-stage renal disease (ESRD). Health-related quality of life was measured by the Short Form (36 questions) health survey questionnaire (SF-36) subscales, mental and physical component summary scores.RESULTS: There were 1827 patients, 89% females, mean (s.d.) age 35.1 (13.3) years. The mean (s.d.) SLE duration at enrolment was 0.5 (0.3) years and follow-up 4.6 (3.4) years. LN occurred in 700 (38.3%) patients: 566/700 (80.9%) at enrolment and 134/700 (19.1%) during follow-up. Patients with nephritis were younger, more frequently men and of African, Asian and Hispanic race/ethnicity. The estimated overall 10-year incidence of ESRD was 4.3% (95% CI: 2.8%, 5.8%), and with nephritis was 10.1% (95% CI: 6.6%, 13.6%). Patients with nephritis had a higher risk of death (HR = 2.98, 95% CI: 1.48, 5.99; P = 0.002) and those with eGFR <30 ml/min at diagnosis had lower SF-36 physical component summary scores (P < 0.01) and lower Physical function, Physical role and Bodily pain scores. Over time, patients with abnormal eGFR and proteinuria had lower SF-36 mental component summary (P ≤ 0.02) scores compared to patients with normal values.CONCLUSION: LN occurred in 38.3% of SLE patients, frequently as the initial presentation, in a large multi-ethnic inception cohort. Despite current standard of care, nephritis was associated with ESRD and death, and renal insufficiency was linked to lower health-related quality of life. Further advances are required for the optimal treatment of LN.
KW - Adult
KW - Disease Progression
KW - Ethnic Groups
KW - Female
KW - Follow-Up Studies
KW - Global Health
KW - Humans
KW - Incidence
KW - Lupus Nephritis
KW - Male
KW - Outcome Assessment (Health Care)
KW - Prospective Studies
KW - Quality of Life
KW - Risk Factors
KW - Surveys and Questionnaires
KW - Survival Rate
KW - Journal Article
KW - Multicenter Study
KW - Research Support, N.I.H., Extramural
KW - Research Support, Non-U.S. Gov't
U2 - 10.1093/rheumatology/kev311
DO - 10.1093/rheumatology/kev311
M3 - Article
SN - 1462-0324
VL - 55
SP - 252
EP - 262
JO - Rheumatology
JF - Rheumatology
IS - 2
ER -