title: Anti-malarials exert a protective effect while Mestizo patients are at increased risk of developing SLE renal disease: data from a Latin-American cohort.
abstract: OBJECTIVE
  To examine the role of ethnicity and the use of anti-malarials (protective) on lupus renal disease.
  
  
  METHODS
  A nested case-control study (1:2 proportion, n = 265 and 530) within GLADEL's (Grupo Latino Americano De Estudio de Lupus) longitudinal inception cohort was carried out. The end-point was ACR renal criterion development after diagnosis. Cases and controls were matched for follow-up time (end-point or a comparable time, respectively). Renal disease predictors were examined by univariable and multivariable analyses. Additional analyses were done to determine if the protective effect of anti-malarials persisted after adjusting for intake-associated confounders.
  
  
  RESULTS
  Of the cases, 233 (87.9%) were women; their mean (s.d.) age at diagnosis was 28.0 (11.9) years and their median (Q3-Q1 interquartile range) follow-up time for cases and controls was 8.3 months (Q3-Q1: 23.5); 56.6% of the cases and 74.3% of the controls were anti-malarial users. Mestizo ethnicity [odds ratio (OR) 1.72, 95% CI 1.19, 2.48] and hypertension (OR 2.26, 95% CI 1.38, 3.70) were independently associated with a higher risk of renal disease, whereas anti-malarial use (OR 0.39, 95% CI 0.26, 0.58), older age at disease onset (OR 0.98, 95% CI 0.96, 0.99) and female gender (OR 0.56, 95% CI 0.32, 0.99) were negatively associated with such occurrence. After adjusting for variables associated with their intake, the protective effect of anti-malarials on renal disease occurrence persisted (OR 0.38, 95% CI 0.25, 0.58).
  
  
  CONCLUSIONS
  Mestizo patients are at increased risk of developing renal disease, whereas anti-malarial use protects patients from such an occurrence.
authors.affiliation: Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, Catalonia, Spain.
authors.forename: Guillermo J
authors.initials: GJ
authors.lastname: Pons-Estel
authors.forename: Graciela S
authors.initials: GS
authors.lastname: Alarcón
authors.forename: Leticia
authors.initials: L
authors.lastname: Hachuel
authors.forename: Gabriela
authors.initials: G
authors.lastname: Boggio
authors.forename: Daniel
authors.initials: D
authors.lastname: Wojdyla
authors.forename: Virginia
authors.initials: V
authors.lastname: Pascual-Ramos
authors.forename: Enrique R
authors.initials: ER
authors.lastname: Soriano
authors.forename: Verónica
authors.initials: V
authors.lastname: Saurit
authors.forename: Fernando S
authors.initials: FS
authors.lastname: Cavalcanti
authors.forename: Renato A
authors.initials: RA
authors.lastname: Guzman
authors.forename: Marlene
authors.initials: M
authors.lastname: Guibert-Toledano
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Sauza Del Pozo
authors.forename: Mary-Carmen
authors.initials: MC
authors.lastname: Amigo
authors.forename: Magaly
authors.initials: M
authors.lastname: Alva
authors.forename: Maria H
authors.initials: MH
authors.lastname: Esteva-Spinetti
authors.forename: Bernardo A
authors.initials: BA
authors.lastname: Pons-Estel
mesh_terms: D000328:Adult; D017668:Age of Onset; D000962:Antimalarials / Q000627:therapeutic use*; D001118:Argentina / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008181:Lupus Nephritis / Q000175:diagnosis / Q000208:ethnology / Q000517:prevention & control*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials