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Observational Study
. 2018 May;45(5):671-677.
doi: 10.3899/jrheum.161554. Epub 2018 Mar 1.

Renal Remission Status and Longterm Renal Survival in Patients with Lupus Nephritis: A Retrospective Cohort Analysis

Julie E Davidson  1   2 , Qinggong Fu  1   2 , Beulah Ji  3   4 , Sapna Rao  1   2 , David Roth  1   2 , Laurence S Magder  1   2 , Michelle Petri  1   2
Affiliations
Observational Study

Renal Remission Status and Longterm Renal Survival in Patients with Lupus Nephritis: A Retrospective Cohort Analysis

Julie E Davidson et al. J Rheumatol. 2018 May.

Abstract

Objective: This observational study was a retrospective analysis of prospectively collected Hopkins Lupus Cohort data to compare longterm renal survival in patients with lupus nephritis (LN) who achieved complete (CR), partial (PR), or no remission following standard-of-care LN induction therapy.

Methods: Eligible patients with biopsy-proven LN (revised American College of Rheumatology or Systemic Lupus Collaborating Clinics criteria) were identified and categorized into ordinal (CR, PR, or no remission) or binary (response or no response) renal remission categories at 24 months post-diagnosis [modified Aspreva Lupus Management Study (mALMS) and modified Belimumab International Lupus Nephritis Study (mBLISS-LN) criteria]. The primary endpoint was longterm renal survival [without endstage renal disease (ESRD) or death].

Results: In total, 176 patients met the inclusion criteria. At Month 24 postbiopsy, more patients met mALMS remission criteria (CR = 59.1%, PR = 30.1%) than mBLISS-LN criteria (CR = 40.9%, PR = 16.5%). During subsequent followup, 18 patients developed ESRD or died. Kaplan-Meier plots suggested patients with no remission at Month 24 were more likely than those with PR or CR to develop the outcome using either mALMS (p = 0.0038) and mBLISS-LN (p = 0.0097) criteria for remission. Based on Cox regression models adjusted for key confounders, those in CR according to the mBLISS-LN (HR 0.254, 95% CI 0.082-0.787; p = 0.0176) and mALMS criteria (HR 0.228, 95% CI 0.063-0.828; p = 0.0246) were significantly less likely to experience ESRD/mortality than those not in remission.

Conclusion: Renal remission status at 24 months following LN diagnosis is a significant predictor of longterm renal survival, and a clinically relevant endpoint.

Keywords: COHORT STUDIES; ENDSTAGE RENAL DISEASE; LUPUS NEPHRITIS; MORTALITY; REMISSION INDUCTION; SURVIVAL.

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Conflict of interest statement

Author conflict of interest disclosures:

JED: Shareholder of GSK; employee of GSK at the time of study; current employee of Eli Lilly and Company Ltd

QF: Shareholder of GSK; employee of GSK

BJ: Shareholder of GSK; employee of GSK

SR: Employee of GSK; student at University of North Carolina at Chapel Hill

DR: Shareholder of GSK; employee of GSK

LSM: None

MP: Consultant for and recipient of research grants from GSK

Figures

Figure 1
Figure 1. Study design
aDegree of remission status achieved at Month 24 post LN biopsy data, was used as the key exposure variable in this study. Renal remission status was also defined retrospectively at other study time points (Month 6 and Month 36) bClosest date to Day 0 (LN biopsy date) within period 3 months prior to Day 0 to 3 months post Day 0 cClosest date to Day 730 (Month 24) within a period of 3 months prior to Month 24 to 3 months post Month 24 dClosest date to Day 1095 (Month 36) within a period of 3 months prior to 3 months post Month 36 LN, lupus nephritis
Figure 2
Figure 2. Long-term renal survival based on remission category at 24 months post biopsy: A. mALMS criteria (ordinal) B. mBLISS-LN criteria (ordinal) C. proteinuria (binary criteria)
CR, complete remission; mALMS, modified Aspreva Lupus Management Study; mBLISS-LN, modified Belimumab International Lupus Nephritis Study; PR, partial remission; Pr:Cr, protein:creatinine Cut-off of 0.8g/day selected due to a recent publication (16)
Figure 3
Figure 3. Long-term chronic renal insufficiency-free survival based on status at 24 months: A. mALMS criteria (ordinal) B. mBLISS-LN criteria (ordinal) C. proteinuria (binary criteria)
CR, complete remission; mALMS, modified Aspreva Lupus Management Study; mBLISS-LN, modified Belimumab International Lupus Nephritis Study; PR, partial remission; Pr:Cr, protein:creatinine Cut-off of 0.8g/day selected due to a recent publication (16)
See this image and copyright information in PMC

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