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Kidney Week

Abstract: PO1597

Early Predictors for Stable Kidney Function in Lupus Nephritis

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Mejia-Vilet, Juan M., National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, CDMX, Mexico
  • Gerrard, Megan Ashley Navarro, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, CDMX, Mexico
  • Comunidad Bonilla, Roque Armando, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, CDMX, Mexico
  • Morales-Buenrostro, Luis E., National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, CDMX, Mexico
Background

Early prediction of outcomes in LN is essential to adjust LN treatment. The aim of this study was to evaluate the early course of laboratory parameters and their association with long-term stability of kidney function.

Methods

We studied 433 patients from our local LN cohort recruited between 2008 and 2017. All patients had >36 months follow-up and complete evaluation at LN flare, 3-, 6-, and 12-months of follow up with hemoglobin, creatinine, 24h-proteinuria, albumin, anti-dsDNA-Ab, complement C3 and C4 fragments. The main outcome was stable kidney function defined as eGFR within 25% of the best eGFR attained in the first 12 months of treatment. Each variable was evaluated individually by ROC curves and in association with other variables. The change in area under the curve (AUC) was analyzed with De Long’s test.

Results

Median follow up was 73 months (IQR 51-101). Kidney survival was 90% and 81% at 3- and 5-years, respectively. Stability of kidney function was 77% and 65% at 3- and 5-years, respectively. The predictive performance of each parameter varied with the timepoint where evaluated (Table). Serum albumin and hemoglobin AUCs improved from baseline to the 3- and 6-month timepoint. Proteinuria and eGFR AUCs improved at each timepoint up to the 12-month timepoint. C3, C4, and anti-dsDNA-Ab level did not improve at any timepoint vs. baseline. The best predictor of 36-month eGFR stability was proteinuria <1.0g/g by 12 months. The sum of proteinuria plus eGFR provided the best combined AUC at each timepoint (Figure 1).

Conclusion

Early course of albumin, hemoglobin, and serological parameters does not improve prediction for stable kidney function in LN. The predictive performance of each biomarker improves over time. The combination of proteinuria and eGFR remains the best predictor of kidney outcomes.

Table 1. Area under the curve (AUC) of the evaluated parameters to predict stable kidney function by 36 months.

Figure 1. ROC curves of proteinuria (A), eGFR (B), and the sum of proteinuria plus eGFR (C) to predict stable kidney function by 36 months.