Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Feb;63(2):206-13.
doi: 10.1053/j.ajkd.2013.08.010. Epub 2013 Oct 4.

Development of reduced kidney function in rheumatoid arthritis

LaTonya J Hickson  1 , Cynthia S Crowson  2 , Sherine E Gabriel  3 , James T McCarthy  4 , Eric L Matteson  5
Affiliations

Development of reduced kidney function in rheumatoid arthritis

LaTonya J Hickson et al. Am J Kidney Dis. 2014 Feb.

Abstract

Background: Rheumatoid arthritis (RA) is associated with a variety of kidney disorders. However, it is unclear whether the development of reduced kidney function is higher in patients with RA compared to the general population.

Study design: Retrospective review.

Setting & participants: Incident adult-onset RA cases (813) and a comparison cohort of non-RA individuals (813) in Olmsted County, MN, in 1980-2007.

Predictor: Baseline demographic and clinical variables.

Outcomes: Reduced kidney function: (1) estimated glomerular filtration rate (eGFR)<60mL/min/1.73m(2) and (2) eGFR<45mL/min/1.73m(2) on 2 consecutive occasions at least 90 days apart; cardiovascular disease (CVD); and death.

Measurements: The cumulative incidence of reduced kidney function was estimated adjusting for the competing risk of death.

Results: Of 813 patients with RA and 813 non-RA individuals, mean age was 56±16 (SD) years, 68% were women, and 9% had reduced kidney function at baseline. The 20-year cumulative incidence of reduced kidney function was higher in patients with RA compared with non-RA participants for eGFR < 60mL/min/1.73m(2) (25% vs 20%; P=0.03), but not eGFR<45mL/min/1.73m(2) (9% vs 10%; P=0.8). The presence of CVD at baseline (HR, 1.77; 95% CI, 1.14-2.73; P=0.01) and elevated erythrocyte sedimentation rate in patients with RA (HR per 10-mm/h increase, 1.08; 95% CI, 1.00-1.16; P=0.04) was associated with increased risk of eGFR<60mL/min/1.73m(2). eGFR<60mL/min/1.73m(2) was not associated with increased risk of CVD development in patients with RA (HR, 0.99; 95% CI, 0.63-1.57; P=0.9), however, a greater reduction in GFR (eGFR<45mL/min/1.73m(2)) was associated with increased risk of CVD (HR, 1.93; CI, 1.04-3.58; P=0.04).

Limitations: Reduced kidney function was defined by estimating equations for kidney function. We are limited to deriving associations from our findings.

Conclusions: Patients with RA were more likely to develop reduced kidney function over time. CVD and associated factors appear to play a role. The presence of RA in individuals with reduced kidney function may lead to an increase in morbidity from CVD development, for which awareness may provide a means for optimizing care.

Keywords: Cardiovascular disease; estimated glomerular filtration rate (eGFR); glomerulonephritis; kidney dysfunction; mortality; renal progression; rheumatoid arthritis (RA).

PubMed Disclaimer

Figures

Figure 1
Figure 1
Cumulative incidence of eGFR<60 mL/min/1.73 m2 in rheumatoid arthritis (RA) vs. non-RA. The solid line represents patients with RA and the dashed line those without RA (p=0.03).
See this image and copyright information in PMC

Comment in

References

    1. Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. Jama. 2007 Nov 7;298(17):2038–2047. - PubMed
    1. Helin HJ, Korpela MM, Mustonen JT, Pasternack AI. Renal biopsy findings and clinicopathologic correlations in rheumatoid arthritis. Arthritis Rheum. 1995 Feb;38(2):242–247. - PubMed
    1. Karie S, Gandjbakhch F, Janus N, et al. Kidney disease in RA patients: prevalence and implication on RA-related drugs management: the MATRIX study. Rheumatology (Oxford) 2008 Mar;47(3):350–354. - PubMed
    1. Nakamura T, Higashi S, Tomoda K, Tsukano M, Shono M. Etanercept can induce resolution of renal deterioration in patients with amyloid A amyloidosis secondary to rheumatoid arthritis. Clin Rheumatol. 2010 Dec;29(12):1395–1401. - PubMed
    1. Nakano M, Ueno M, Nishi S, et al. Analysis of renal pathology and drug history in 158 Japanese patients with rheumatoid arthritis. Clin Nephrol. 1998 Sep;50(3):154–160. - PubMed

Publication types