Abstract: FR-PO402

Biologic Use and Incident CKD in Rheumatoid Arthritis

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 301 CKD: Risk Factors for Incidence and Progression

Authors

  • Sumida, Keiichi, Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, kanagawa, Japan
  • Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Potukuchi, Praveen Kumar, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Hassan, Fatima, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Thomas, Fridtjof, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Yamagata, Kunihiro, University of Tsukuba, Tsukuba, Japan
  • Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
Background

Rheumatoid arthritis (RA) is associated with reduced kidney function, possibly due to chronic inflammation or the use of nephrotoxic therapies. Little is known about the effects of RA therapy using novel non-nephrotoxic biologic agents on the risk of incident CKD.

Methods

In a nationwide cohort of 20,757 U.S. veterans with an eGFR ≥60 mL/min/1.73 m2 who were newly diagnosed with RA between 2004 and 2006, with follow-up through 2013, we examined the association of the use of biologic agents with incident CKD (>25% decrease in eGFR reaching <60 mL/min/1.73m2) and change in eGFR (<-3, -3-<0 [reference], and ≥0 mL/min/1.73m2/year), using time-dependent Cox models and multinomial logistic regression models, respectively, with adjustment for potential confounders.

Results

After multivariable adjustment, patients receiving (vs. not receiving) biologic treatment had a lower risk of incident CKD (adjusted HRs [95% CI], 0.83 [0.72-0.96]) and progressive eGFR decline (adjusted multinomial ORs [95% CI] for eGFR slopes <-3 and ≥0 [vs. -3-<0] mL/min/1.73m2/year, 0.82 [0.72-0.95] and 1.03 [0.95-1.12], respectively) (Figure). A significant deceleration of eGFR decline was also observed after biologic administration in patients treated with biologics (-1.0±1.9 vs. -0.4±2.2 [mL/min/1.73m2/year] before and after biologic use, respectively, P <0.001).

Conclusion

Biologic treatment was independently associated with lower risk of incident CKD and progressive eGFR decline. Clinical trials are warranted to test whether active interventions with biologic agents can prevent adverse renal outcomes associated with RA.

Funding

  • NIDDK Support