Factors associated with poor outcomes in patients with lupus nephritis.
The objective of this study was to identify the factors associated with important clinical outcomes in a case-control study of 213 patients with lupus nephritis. Included were 47% Hispanics, 44% African Americans and 9% Caucasians with a mean age of 28 years. Fifty-four (25%) patients reached the primary composite outcome of doubling serum creatinine, end-stage renal disease or death during a mean follow-up of 37 months. Thirty-four percent African Americans, 20% Hispanics and 10% Caucasians reached the primary composite outcome (P < 0.05). Patients reaching the composite outcome had predominantly proliferative lupus nephritis (WHO classes: 30% III, 32% IV, 18% V and 5% II, P < 0.025) with higher activity index score (7 +/- 6 versus 5 +/- 5, P < 0.05), chronicity index (CI) score (4 +/- 3 versus 2 +/- 2 unit, P < 0.025), higher baseline mean arterial pressure (MAP) (111 +/- 21 versus 102 +/- 14 mmHg, P < 0.025) and serum creatinine (1.9 +/- 1.3 versus 1.3 +/- 1.0 mg/dL, P < 0.025), but lower baseline hematocrit (29 +/- 6 versus 31 + 5%, P < 0.025) and complement C3 (54 +/- 26 versus 65 + 33 mg/dL, P < 0.025) compared to controls. More patients reaching the composite outcome had nephrotic range proteinuria compared to controls (74% versus 56%, P < 0.025). By multivariate analysis, CI (hazard ratio [95% CI] 1.18 [1.07-1.30] per point), MAP (HR 1.02 [1.00-1.03] per mmHg), and baseline serum creatinine (HR 1.26 [1.04-1.54] per mg/dL) were independently associated with the composite outcome. We concluded that hypertension and elevated serum creatinine at the time of the kidney biopsy as well as a high CI are associated with an increased the risk for chronic renal failure or death in patients with lupus nephritis.
Contreras
G
G
Acute Dialysis Unit Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL 33101, USA. gcontrer@med.miami.edu
Pardo
V
V
Cely
C
C
Borja
E
E
Hurtado
A
A
De La Cuesta
C
C
Iqbal
K
K
Lenz
O
O
Asif
A
A
Nahar
N
N
Leclerq
B
B
Leon
C
C
Schulman
I
I
Ramirez-Seijas
F
F
Paredes
A
A
Cepero
A
A
Khan
T
T
Pachon
F
F
Tozman
E
E
Barreto
G
G
Hoffman
D
D
Almeida Suarez
M
M
Busse
J C
JC
Esquenazi
M
M
Esquenazi
A
A
Garcia Mayol
L
L
Garcia Estrada
H
H
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000401:mortality*; D008181:Lupus Nephritis / Q000208:ethnology / Q000401:mortality*; D008297:Male; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D044465:White People / Q000706:statistics & numerical data
D003404:Creatinine