Disease-specific quality of life in patients with lupus nephritis

Jolly, Meenakshi; Toloza, Sergio; Göker, Berna; Clarke, Ann E.; Navarra, Sandra V.; Wallace, DJ; Weisman, MH; Mok, Chi Chiu

doi:10.1177/0961203317717082

Cited by 44 publications

(36 citation statements)

References 18 publications

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“…We found no impact of anticoagulation [55], antihypertensives (no comparable data), mood stabilisers [55], and NSAIDs [59] on HRQoL. For the routine laboratory findings, we found that HbA1c (%) negatively impacted MH, aligning with the glycaemic control literature [60,61], but that the levels of proteinuria and anti-dsDNA antibodies were not related to HRQoL [7,26,62,63]. An increasing C3 level led to higher SF; however, the levels or hypocomplementemia of C3 or C4 did not influence any other HRQoL item.…”

Section: Discussionmentioning

confidence: 60%

The Impact of Cytokines on the Health-Related Quality of Life in Patients with Systemic Lupus Erythematosus

Raymond

Eilertsen

Shanmugakumar

et al. 2019

JCM

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Introduction: Systemic lupus erythematosus (SLE) reduces the health-related quality of life (HRQoL), even during periods of disease quiescence. We investigated whether subclinical inflammation as reflected by cytokine levels is linked with reduced HRQoL. Methods: A cross-sectional study of SLE patients (n = 52, mean age 47.3, 86.5% female) who completed a Short Form Health Survey-36 (SF-36) questionnaire. The clinical and demographic data, scores for the disease activity (SLEDAI-2K), organ damage (SDI), and laboratory data were collected simultaneously. The autoantibody and cytokine levels (IFN-γ, IL-1β, IL-4, IL-6, IL-10, IL-12, IL-17, BAFF, TNF-α, TGF-β1, MIP-1α, MIP-1β and MCP-1 (levels in pg/mL) were quantified by sandwich ELISA. The comparisons and associations were assessed non-parametrically, and a multiple regression determined the effect sizes (ES) of the variables on the SF-36 domain and summary scores. Results: The SF-36 summary and domain scores for SLE patients were significantly (20–40%) lower than in a comparable control group, with the exception of the Mental Health scores (p = 0.06). SLE patients had a normal body mass index (BMI) (median, 24.2 kg/m2), a high rate of smoking (69.2%), and usage of social security benefits (90.4%). TGF-β1 (ES 0.06), IL-12 (ES −0.11), IFN-γ (ES 0.07) and MCP-1 (ES 0.06) influenced the SF-36 domain scores; and MCP-1 (ES 0.04) influenced the Mental Health Summary Score (MCS). Obvious manifestations, including patient visual analogue scale (VAS) (ES −2.84 to −6.29), alopecia (ES −14.89), malar rash (ES −14.26), and analgesic requirement (ES −19.38), independently influenced the SF-36 items; however, the SF-36 scores were not reflected by the physician VAS or disease activity (SLEDAI-2K). Conclusions: Cytokines had a minimal impact on HRQoL in SLE patients, especially compared to visible skin manifestations, central nervous system (CNS) damage, and pain. Better tools are needed to capture HRQoL in measures of disease activity.

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Section: Discussionmentioning

confidence: 60%

The Impact of Cytokines on the Health-Related Quality of Life in Patients with Systemic Lupus Erythematosus

Raymond

Eilertsen

Shanmugakumar

et al. 2019

JCM

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“…Notably, the patient-reported outcomes of life participation, fatigue, anxiety, and family impact were highly prioritized by patients and caregivers. Patients with active glomerular disease have a poor health-related quality of life, and they often have anxiety and depression (24,(37)(38)(39)(40). Fatigue is a frequent, under-recognized, and highly disabling symptom in patients with vasculitis (10,41), but it is also of concern in those with kidney-limited glomerular disease or nephrotic conditions, and it is worst in those who are on dialysis (37,40,42).…”

Section: Discussionmentioning

confidence: 99%

Identifying Outcomes Important to Patients with Glomerular Disease and Their Caregivers

Carter

Gutman

Logeman

et al. 2020

CJASN

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Background and objectivesShared decision making in patients with glomerular disease remains challenging because outcomes important to patients remain largely unknown. We aimed to identify and prioritize outcomes important to patients and caregivers and to describe reasons for their choices.Design, setting, participants, & measurementsWe purposively sampled adult patients with glomerular disease and their caregivers from Australia, Hong Kong, the United Kingdom, and the United States. Participants identified, discussed, and ranked outcomes in focus groups using the nominal group technique; a relative importance score (between zero and one) was calculated. Qualitative data were analyzed thematically.ResultsAcross 16 focus groups, 134 participants (range, 19–85 years old; 51% women), including 101 patients and 33 caregivers, identified 58 outcomes. The ten highest-ranked outcomes were kidney function (importance score of 0.42), mortality (0.29), need for dialysis or transplant (0.22), life participation (0.18), fatigue (0.17), anxiety (0.13), family impact (0.12), infection and immunity (0.12), ability to work (0.11), and BP (0.11). Three themes explained the reasons for these rankings: constraining day-to-day experience, impaired agency and control over health, and threats to future health and family.ConclusionsPatients with glomerular disease and their caregivers highly prioritize kidney health and survival, but they also prioritize life participation, fatigue, anxiety, and family impact.

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“…Mortality in SLE increases at least 1.2-fold when the kidney is affected [ 3 ], and 10-year cumulative renal survival in patients with proliferative lupus nephritis (LN) ranges from 74 to 81% [ 4 , 5 ]. Moreover, glomerulonephritis in patients with SLE significantly reduces their quality of life [ 6 ] and working ability [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Urinary angiostatin, CXCL4 and VCAM-1 as biomarkers of lupus nephritis

Mok

Soliman

et al. 2018

Arthritis Res Ther

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BackgroundThe aim was to study urinary angiostatin, CXC chemokine ligand 4 (CXCL4) and vascular cell adhesion molecule-1 (VCAM-1) as biomarkers of renal disease in systemic lupus erythematosus (SLE).MethodPatients who fulfilled ≥ 4 American College of Rheumatology (ACR) criteria for SLE with active renal, active non-renal or inactive disease, and a group of healthy controls were studied. Urine samples were assayed for angiostatin, CXCL4 and VCAM-1 by ELISA, and normalized by creatinine. Receiver operating characteristic analysis was performed to obtain the best cutoff values to calculate the performance of these markers in differentiating the different groups of patients as compared to anti-double-stranded DNA (anti-dsDNA) and complement C3. Correlation between these urinary biomarkers and various renal parameters was also tested.ResultsPatients with SLE (n = 227; 80 with inactive SLE, 67 with active non-renal disease and 80 with active renal disease; 94% women; age 39.2 ± 13.8 years) and 53 controls (96% women) were studied. All were ethnic Chinese. Urinary angiostatin, CXCL4 and VCAM-1 (normalized for creatinine) were significantly higher in patients with active renal disease than in patients with active non-renal disease, patients with inactive SLE and controls. These markers correlated significantly with total SLE disease activity index (SLEDAI) and renal SLEDAI scores, and with the urinary protein-to-creatinine ratio. Urine angiostatin exhibited higher specificity and sensitivity in differentiating active renal from active non-renal SLE (area under the curve (AUC) 0.87) than serum anti-dsDNA/C3. Urine CXCL4 (AUC 0.64) and VCAM-1 (AUC 0.73), on the other hand, performed similarly to anti-dsDNA/C3. All three markers performed comparably to anti-dsDNA/C3 in distinguishing active from inactive SLE. In a subgroup of 68 patients with paired renal biopsy, the urinary levels of these proteins did not differ significantly between the proliferative and non-proliferative types of lupus nephritis. Urinary CXCL4 and VCAM-1 correlated significantly with the histologic activity score, and urinary angiostatin correlated significantly with proteinuria in this subgroup.ConclusionsUrinary angiostatin, CXCL4 and VCAM-1 are potential biomarkers for SLE, in particular lupus nephritis. Further longitudinal studies are necessary to delineate the performance of these markers in predicting renal flares and prognosis in SLE patients.

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Disease-specific quality of life in patients with lupus nephritis

Cited by 44 publications

References 18 publications

The Impact of Cytokines on the Health-Related Quality of Life in Patients with Systemic Lupus Erythematosus

The Impact of Cytokines on the Health-Related Quality of Life in Patients with Systemic Lupus Erythematosus

Identifying Outcomes Important to Patients with Glomerular Disease and Their Caregivers

Urinary angiostatin, CXCL4 and VCAM-1 as biomarkers of lupus nephritis

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