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Abstract: TH-PO623

Sex Differences in Lupus Nephritis: A Meta-Regression Analysis

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Mahmood, Salman Bin, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
  • Aziz, Muhammad, The University of Toledo Medical Center, Toledo, Ohio, United States
  • Malepati, Deepthi Chandra, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
  • Lee-Smith, Wade M., The University of Toledo Libraries, Toledo, Ohio, United States
  • Clark, Justin, University of Minnesota Twin Cities School of Public Health, Minneapolis, Minnesota, United States
  • Brearley, Ann M., University of Minnesota Twin Cities School of Public Health, Minneapolis, Minnesota, United States
  • Nachman, Patrick H., University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
Background

More frequent and severe lupus nephritis (LN) has been reported in men compared to women, but data are limited and inconsistent. We performed a meta-analysis to compare the histopathologic findings and outcomes between men and women with biopsy-proven LN (BPLN).

Methods

We conducted a systematic search of electronic databases through 2021 using the terms "lupus nephritis” and “sex/gender”. Screening was limited to studies of adult patients with BPLN. We compared the biopsy findings and outcomes between the sexes. Pooled odds ratios (OR) with 95% confidence intervals (CI) were generated, and meta-regression performed to assess the impact of several covariates, using random-effects models.

Results

25 studies were included (1210 men and 6635 women). 20 studies reported kidney histopathology, 11 kidney outcomes and 8 mortality rates. Men had a higher OR for class IV±V LN (1.26, 95% CI: 1.01-1.56) and the composite kidney outcome (doubling serum creatinine, kidney replacement therapy or eGFR<15 ml/min) (2.20, 95% CI: 1.59-3.06) and a lower OR for complete remission (0.52, 95% CI: 0.39-0.68) (Fig. 1). Meta-regression did not reveal statistically significant study-level relationships between sex differences in any of the covariates and the composite kidney outcome (Table 1).

Conclusion

Our analysis confirms the association between male sex and increased LN severity as well as worse kidney outcomes. Larger prospective studies are needed to validate this association and inform treatment strategies that may hold unique value for this high-risk population.

Figure 1. Forest plots showing the estimated OR with 95% CI for men with BPLN compared to women.

Table 1. Meta-regression analysis for the effect of sex differences on the composite kidney outcome.