Long-term renal outcomes of systemic lupus erythematosus in a Taiwanese population: a single-center retrospective study

Abstract

Objective: To investigate the long-term outcome of patients with systemic lupus erythematosus (SLE) who presented with renal involvement in a Taiwanese population.

Methods: Data of patients diagnosed with SLE at Changhua Christian Hospital Clinical Research Database from January 2010 until December 2021 were retrospectively reviewed. Participants were categorized according to the presence of renal involvement, defined as a high protein-to-creatinine ratio or positive histopathology of kidney biopsy. Incidence rates and risk factors of chronic kidney disease (CKD) and end-stage renal disease (ESRD) were analyzed.

Results: A total of 2184 eligible patients with SLE were enrolled, of which 293 had renal involvement. The risk of CKD/ESRD development was higher among participants with renal involvement compared with those without renal involvement. The median times to development of CKD and ESRD were 2.03 years (IQR: 0.13-6.33) and 7.34 years (IQR: 3.13-10.41), respectively, among renal involvement participants. The cumulative incidence rates of CKD were 46.6%, 54.5%, and 63% at 1, 2, and 5 years after renal involvement, respectively, and those of ESRD were 4%, 7%, and 11%, respectively. In the subgroups of two definitions (PCR- or biopsy-defined renal involvement) for renal involvement, the incidence rate of developing CKD/ESRD was not significantly different between the groups. Multivariate analysis revealed that factors associated with CKD development were renal involvement, age, hypertension, and serositis.

Conclusion: Among the Taiwanese population, compared with patients without renal involvement, patients with renal involvement were at a higher risk of developing CKD, and the 5-year incidence rate of ESRD is 11% in this study. Key Points • Among the patients with systemic lupus erythematosus in the Taiwanese population, patients with renal involvement were at a higher risk of developing CKD and ESRD. • The median times-to-development of CKD and ESRD were 2.03 (IQR: 0.13-6.33) years and 7.34 (IQR: 3.13-10.41) years, respectively, among renal involvement participants, whilst the cumulative incidence rates of CKD and ESRD at 5 years after renal involvement were 63% and 11%, respectively. • Subgroup analyses to investigate patients with PCR- and biopsy-defined renal involvement were additionally performed in this study, revealing similar incidence rates of CKD and ESRD in both subgroups.

Keywords: Lupus nephritis; Outcome; Prognosis.