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Abstract: FR-PO896

Risk Factors for Poor Long-Term Renal Outcome and Death in Lupus Nephritis: Analysis on a Nationwide Cohort Study in Japan

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Ikeuchi, Hidekazu, Gunma University, Maebashi, Japan
  • Hiromura, Keiju, Gunma University, Maebashi, Japan
  • Sugiyama, Hitoshi, Okayama University, Okayama, Japan
  • Sato, Hiroshi, Tohoku University, Sendai, Japan
  • Yokoyama, Hitoshi, Kanazawa Medical University, Uchinada, Japan
  • Nojima, Yoshihisa, Inoue Hospital, Takasaki, Japan

Group or Team Name

  • On Behalf of the JSN Lupus Nephritis Study Group.
Background

We previously reported the outcomes of adult lupus nephritis (LN) in a recent nationwide retrospective cohort study in Japan (ASN 2018). Here we aimed to determine risk factors for poor long-term renal outcome and death.

Methods

Adult patients who received renal biopsy between 2007 and 2012 at 27 institutions and were registered in the Japan Renal Biopsy Registry as LN were analyzed. Poor renal outcome was defined as doubling serum creatinine (S-Cr) or end-stage renal disease (ESRD).

Results

498 patients (88 male), median age 39 (IQR, 30-52) years-old were evaluated. Clinical data at the renal biopsy and the frequency of ISN/RPS Class were as follows: median eGFR 78.3 (IQR, 56.3-100.8) ml/min/1.73m2, median urinary protein 2.04 (IQR, 0.87-4.30) g/gCr, Class I, 1.6%; II, 5.8%; III, 26.9%; IV, 46.6%; V, 18.5%; VI, 0.6%. Among 498 patients, 36 patients (7.0%) reached doubling S-Cr or ESRD, during the median observation period of 63 months (IQR, 49-82). Death was observed in 28 patients (infection, 14 pts; cardiovascular disease, 6 pts; malignant tumor, 4 pts; others, 4 pts). Univariate analysis revealed age, body mass index (BMI), systolic BP, serum albumin, urinary protein, eGFR and Class IV LN were significant risk factors for poor renal outcome (P <0.05). Multivariate analysis revealed BMI (HR, 1.11; 95%CI, 1.02-1.21; P=0.012) and eGFR (HR, 0.98; 95%CI 0.96-1.00; P=0.019) were independent risk factors. As risk factors for death, age, systolic blood pressure, serum albumin, eGFR and urinary protein were identified by univariate analysis (P <0.05). Multivariate analysis revealed age (HR, 1.04; 95%CI, 1.01-1.07; P=0.008) and eGFR (HR, 0.97; 95%CI, 0.95-0.99, P<0.001). Among 348 patients who received renal biopsy for the first time, 22 patients reached doubling S-Cr or ESRD and 28 patients died. Multivariate analysis also identified BMI (HR, 1.13; 95%CI 1.01-1.27; P=0.032) and eGFR (HR, 0.98; 95%CI 0.96-1.00; P=0.028) for poor renal outcome and age (HR, 1.04; 95%CI 1.01-1.07; P<0.010) and eGFR (HR, 0.97; 95%CI 0.95-0.99; P=0.003) for death.

Conclusion

Using recent data of the real-world clinical practice of LN in Japan, we identified BMI and eGFR at the time of renal biopsy as risk factors for poor long-term renal outcome and age and eGFR as risk factors for death.