Factors predictive of long-term mortality in lupus nephritis: a multicenter retrospective study of a Japanese cohort

Abstract

Background: Lupus nephritis (LN) is a major determinant of mortality in systemic lupus erythematosus (SLE). Here we evaluated the association between complete renal response (CR) and mortality in LN. Methods: We retrospectively analyzed the cases of 172 of 201 patients with LN for whom data on the therapeutic response at 6 and 12 months after induction therapy were available. The patients underwent a renal biopsy at Nagasaki University Hospital and community hospitals in Nagasaki between the years 1990 and 2016. We determined the CR rates at 6 and 12 months after induction therapy induction and evaluated the predictive factors for CR and their relationship with mortality. We performed univariate and multivariable competing risks regression analyses to determine the factors predictive of CR. The patients' survival data were analyzed by the Kaplan-Meier method with a log-rank test. Results: The median follow-up duration after renal biopsy was 120 months (interquartile range: 60.3-191.8 months). The 5-, 10-, 15-and 20-year survival rates of our cohort were 99.3%, 94.6%, 92.0% and 85.4%, respectively. During follow-up, nine patients (5.2%) died from cardiovascular events, infection, malignancy and other causes. The multivariate analysis revealed that the following factors were predictive of CR. At 6 months: male gender (odds ratio [OR] 0.23, 95% confidence interval [CI] 0.08-0.65, p=0.0028), 4 proteinuria (g/gCr) (OR 0.83, 95%CI 0.71-0.97, p=0.0098) and index of activity (0-24) (OR 0.84, 95%CI 0.71-0.99, p=0.0382). At 12 months: male gender (OR 0.25, 95%CI 0.09-0.67, p=0.0043) and index of activity (0-24) (OR 0.82, 95%CI 0.69-0.98, p=0.0236). The Kaplan-Meier analysis showed that compared to not achieving CR at 12 months, achieving CR at 12 months was significantly correlated with the survival rate (OR 0.18, 95%CI 0.04-0.92, p=0.0339). Conclusions: Our results suggest that the survival rate of patients with LN is associated with the achievement of CR at 12 months after induction therapy, and that male gender and a higher index of activity (0-24) are the common predictive factors for failure to achieve CR at 6 and 12 months.

Long-term predictive value of acute kidney injury classification in diffuse proliferative lupus nephritis with acute kidney injury

“…Besides, the multivariate Cox regression analysis revealed that anemia (Hb < 8.0 g/dl, HR = 4.8) and crescents (more than 30%, HR = 2.1) were independent risk factors for ESRD. These risk factors were also reported in recent studies from Asian LN patients [34][35][36].…”

Comparison of complete renal response and mortality in early- and late-onset lupus nephritis: A multicenter retrospective study of a Japanese cohort

“…Our present ndings also showed that early-onset LN has a lower hazard ratio for mortality compared to late-onset LN (Table 4). In an earlier study, we observed that the survival rate of LN patients was signi cantly correlated with CR attainment at 12 months after the start of induction therapy [13]. We believe that early-onset LN has a higher CR attainment rate at 12 months compared to late-onset LN and that this may be associated with better mortality.…”

“…The results of our analyses demonstrated that early-onset LN was a predictor of CR attainment at 6 and 12 months of treatment. Several studies have indicated that patients with LN who attain a CR have a better survival rate than those who do not attain a CR [13,23,24].…”

“…In our cohort, the predictors of CR after 6 and 12 months of induction therapy were female sex, proteinuria (CR attainment at 6 months only), index of activity (0-24), and early-onset LN. A number of LN studies have also reported that sex [28][29][30], proteinuria at baseline [13,31], and index of activity (0-24) [32][33][34] affect the CR after induction therapy. However, to date, early-onset LN has not been reported to be an independent predictor of CR at 6 and 12 months.…”

“…Association-European Dialysis and Transplant Association (ERA-EDTA) aim for a complete renal response (CR) by 12 months of treatment, but this goal can be extended if nephrotic-range proteinuria is present at baseline [12]. We demonstrated that the survival rate of LN patients was signi cantly correlated with their attainment of a CR at 12 months after the start of induction therapy [13]. Many poor-prognosis factors for LN have been reported, including age, sex, ethnicity, and histological ndings, and we speculated that the prediction of CR attainment at 6 and 12 months of treatment would lead to better renal outcomes and life prognoses [6,14].…”