Good Long-Term Prognosis of Lupus Nephritis in the High-Income Afro-Caribbean Population of Martinique with Free Access to Healthcare

Abstract

Lupus nephritis (LN) has been described as having worse survival and renal outcomes in African-descent patients than Caucasians. We aimed to provide long-term population-based data in an Afro-descendant cohort of LN with high income and easy and free access to specialized healthcare.

Study design: We performed a retrospective population-based analysis using data from 2002-2015 of 1140 renal biopsies at the University Hospital of Martinique (French West Indies). All systemic lupus erythematosus patients with a diagnosis of LN followed for at least 12 months in Martinique or who died during this period were included.

Results: A total of 89 patients were included, of whom 68 (76.4%) had proliferative (class III or IV), 17 (19.1%) had membranous (class V), and 4 (4.5%) had class I or II lupus nephritis according to the ISN/RPS classification. At a mean follow-up of 118.3 months, 51.7% of patients were still in remission. The rates of end-stage renal disease were 13.5%, 19.1%, and 21.3% at 10, 15, and 20 years of follow-up, respectively, and mortality rates were 4.5%, 5.6%, and 7.9% at 10, 15, and 20 years of follow-up, respectively.

Conclusions: The good survival of our Afro-descendant LN patients, similar to that observed in Caucasians, shades the burden of ethnicity but rather emphasizes and reinforces the importance of optimizing all modifiable factors associated with poor outcome, especially socioeconomics.

Keywords: Afro-Caribbean; end-stage renal disease; long-term prognosis; lupus nephritis; mortality; systemic lupus.

Figure 1

Cumulative rates of ESRD (a) and mortality (b) during 1, 5, 10, 15, and 20 years in Martinican patients with lupus nephritis.

Figure 2

Remission, ESRD, and death rates in Martinican patients with lupus nephritis followed for 1, 5, 10, 15, and 20 years. “(n = x)” indicates the remaining patients at the end points. After 1, 5, 10, 15, and 20 years of follow-up, the number of patients lost to follow-up was 2, 4, 7, 4, 2, and 0, respectively. At 1, 5, 10, 15, and 20 years, the number of patients in CR and PR were 38 and 18, 26 and 8, 10 and 4, 1 and 3, and 1 and 1, respectively. Eight patients died: three of infectious origin, one of hemorrhage following abdominal surgery, one of probable massive pulmonary embolism, one of heart failure, and two of unknown cause.

Figure 3

Kaplan Meier analysis of the probability of end-stage renal disease (ESRD) (a) or death (b) in Martinican patients with lupus nephritis. The numbers in brackets refer to the number of remaining patients. Estimated renal survival at 5, 10, 15, and 20 years were 93.2%, 82.3%, 68%, and 51.7%, respectively. Estimated vital survival at 5, 10, 15, and 20 years were 94.9%, 94.9%, 91%, and 66.7%, respectively.