title: Mestizos with systemic lupus erythematosus develop renal disease early while antimalarials retard its appearance: data from a Latin American cohort.
abstract: OBJECTIVE
  The objective of this paper is to assess the predictors of time-to-lupus renal disease in Latin American patients.
  
  
  METHODS
  Systemic lupus erythematosus (SLE) patients (n = 1480) from Grupo Latino Americano De Estudio de Lupus (GLADEL's) longitudinal inception cohort were studied. Endpoint was ACR renal criterion development after SLE diagnosis (prevalent cases excluded). Renal disease predictors were examined by univariable and multivariable Cox proportional hazards regression analyses. Antimalarials were considered time dependent in alternative analyses.
  
  
  RESULTS
  Of the entire cohort, 265 patients (17.9%) developed renal disease after entering the cohort. Of them, 88 (33.2%) developed persistent proteinuria, 44 (16.6%) cellular casts and 133 (50.2%) both; 233 patients (87.9%) were women; mean (± SD) age at diagnosis was 28.0 (11.9) years; 12.2% were African-Latin Americans, 42.5% Mestizos, and 45.3% Caucasians (p = 0.0016). Mestizo ethnicity (HR 1.61, 95% CI 1.19-2.17), hypertension (HR 3.99, 95% CI 3.02-5.26) and SLEDAI at diagnosis (HR 1.04, 95% CI 1.01-1.06) were associated with a shorter time-to-renal disease occurrence; antimalarial use (HR 0.57, 95% CI 0.43-0.77), older age at onset (HR 0.90, 95% CI 0.85-0.95, for every five years) and photosensitivity (HR 0.74, 95% CI 0.56-0.98) were associated with a longer time. Alternative model results were consistent with the antimalarial protective effect (HR 0.70, 95% CI 0.50-0.99).
  
  
  CONCLUSIONS
  Our data strongly support the fact that Mestizo patients are at increased risk of developing renal disease early while antimalarials seem to delay the appearance of this SLE manifestation. These data have important implications for the treatment of these patients regardless of their geographic location.
authors.affiliation: Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Villarroel 170, Barcelona, Catalonia, Spain. gponsestel@yahoo.com
authors.forename: G J
authors.initials: GJ
authors.lastname: Pons-Estel
authors.forename: G S
authors.initials: GS
authors.lastname: Alarcón
authors.forename: P I
authors.initials: PI
authors.lastname: Burgos
authors.forename: L
authors.initials: L
authors.lastname: Hachuel
authors.forename: G
authors.initials: G
authors.lastname: Boggio
authors.forename: D
authors.initials: D
authors.lastname: Wojdyla
authors.forename: R
authors.initials: R
authors.lastname: Nieto
authors.forename: A
authors.initials: A
authors.lastname: Alvarellos
authors.forename: L J
authors.initials: LJ
authors.lastname: Catoggio
authors.forename: M
authors.initials: M
authors.lastname: Guibert-Toledano
authors.forename: J
authors.initials: J
authors.lastname: Sarano
authors.forename: L
authors.initials: L
authors.lastname: Massardo
authors.forename: G M
authors.initials: GM
authors.lastname: Vásquez
authors.forename: A
authors.initials: A
authors.lastname: Iglesias-Gamarra
authors.forename: L T
authors.initials: LT
authors.lastname: Lavras Costallat
authors.forename: N A
authors.initials: NA
authors.lastname: Da Silva
authors.forename: J L
authors.initials: JL
authors.lastname: Alfaro
authors.forename: I
authors.initials: I
authors.lastname: Abadi
authors.forename: M I
authors.initials: MI
authors.lastname: Segami
authors.forename: G
authors.initials: G
authors.lastname: Huerta
authors.forename: M H
authors.initials: MH
authors.lastname: Cardiel
authors.forename: B A
authors.initials: BA
authors.lastname: Pons-Estel
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007843:Latin America / Q000453:epidemiology; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000208:ethnology / Q000503:physiopathology; D008181:Lupus Nephritis / Q000208:ethnology / Q000517:prevention & control*; D008297:Male; D015999:Multivariate Analysis; D010787:Photosensitivity Disorders / Q000453:epidemiology; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
chemical_list: D000962:Antimalarials
keywords: antimalarials; ethnicity; nephritis; renal lupus; systemic lupus erythematosus