Effect of Sustained Clinical Remission on the Risk of Lupus Flares and Impaired Kidney Function in Patients With Lupus Nephritis
Introduction: This retrospective study on patients with biopsy-proven lupus nephritis (LN) aimed to assess the probability of sustained clinical remission (sCR) and to investigate sCR effects on disease flares and impaired kidney function (IKF). Methods: sCR was defined as clinical-Systemic Lupus Er...
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Elsevier
2024-04-01
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| Series: | Kidney International Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024924000172 |
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| author | Mariele Gatto Giulia Frontini Marta Calatroni Francesco Reggiani Roberto Depascale Claudio Cruciani Silvana Quaglini Lucia Sacchi Barbara Trezzi Grazia Dea Bonelli Vincenzo L'Imperio Augusto Vaglio Claudia Furlan Margherita Zen Luca Iaccarino Renato Alberto Sinico Andrea Doria Gabriella Moroni |
| author_facet | Mariele Gatto Giulia Frontini Marta Calatroni Francesco Reggiani Roberto Depascale Claudio Cruciani Silvana Quaglini Lucia Sacchi Barbara Trezzi Grazia Dea Bonelli Vincenzo L'Imperio Augusto Vaglio Claudia Furlan Margherita Zen Luca Iaccarino Renato Alberto Sinico Andrea Doria Gabriella Moroni |
| author_sort | Mariele Gatto |
| collection | DOAJ |
| description | Introduction: This retrospective study on patients with biopsy-proven lupus nephritis (LN) aimed to assess the probability of sustained clinical remission (sCR) and to investigate sCR effects on disease flares and impaired kidney function (IKF). Methods: sCR was defined as clinical-Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) = 0 and estimated glomerular filtration rate (eGFR) >60 ml/min per 1.73 m2 lasting ≥1 year; IKF: eGFR <60 ml/min per 1.73 m2 for >3 months. We analyzed the probability of achieving and maintaining sCR, and the yearly risk of flare. Cox models were used to identify predictors of sCR and IKF with variables analyzed as time-dependent covariates when appropriate. Results: Of 303 patients followed-up with for 14.8 (interquartile range: 9.8–22) years, 257 (84.8%) achieved sCR. The probability of achieving sCR progressively increased over time reaching 90% at 15 years. Baseline age (hazard ratio [HR]: 1.017; 95% confidence interval [CI]: 0.005–1.029; P = 0.004), hydroxychloroquine intake (HR: 1.385; 95% CI: 1.051–1.825; P = 0.021), and absence of arterial hypertension (HR: 0.699; 95% CI: 0.532–0.921; P = 0.011) were independent predictors of sCR. Among patients who achieved sCR, 142 (55.3%) developed a lupus flare after a median time of 3.6 (2.3–5.9) years. In the remaining 115 patients, sCR persisted for 9.5 (5.8–14.5) years. The probability of sCR to persist at 15 years was 38%. SLE flare risk decreased to 10%, 5%, and 2% in patients with sCR lasting <5, 5 to 10, and >10 years, respectively. At the last observation, 57 patients (18.81%) had IKF. sCR achievement (HR: 0.18, P < 0.001) and its duration (HR: 0.83, P < 0.001) were protective against IKF. Conclusion: sCR is an achievable target in LN management and protects against IKF. The longer the sCR, the higher the chance of its persistence and the lower the risk of SLE flares. |
| format | Article |
| id | doaj-art-a852e7bc96134f9da123360e8e3ec83a |
| institution | OA Journals |
| issn | 2468-0249 |
| language | English |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
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| series | Kidney International Reports |
| spelling | doaj-art-a852e7bc96134f9da123360e8e3ec83a2025-08-20T02:06:11ZengElsevierKidney International Reports2468-02492024-04-01941047105610.1016/j.ekir.2024.01.016Effect of Sustained Clinical Remission on the Risk of Lupus Flares and Impaired Kidney Function in Patients With Lupus NephritisMariele Gatto0Giulia Frontini1Marta Calatroni2Francesco Reggiani3Roberto Depascale4Claudio Cruciani5Silvana Quaglini6Lucia Sacchi7Barbara Trezzi8Grazia Dea Bonelli9Vincenzo L'Imperio10Augusto Vaglio11Claudia Furlan12Margherita Zen13Luca Iaccarino14Renato Alberto Sinico15Andrea Doria16Gabriella Moroni17Academic Rheumatology Centre, Department of Clinical and Biological Sciences, University of Turin, Mauriziano Hospital, Turin, Italy; Rheumatology Unit, Department of Medicine, University of Padua, ItalyNephrology and Dialysis Unit, San Paolo Hospital, Milan, ItalyNephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, ItalyNephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, ItalyRheumatology Unit, Department of Medicine, University of Padua, ItalyRheumatology Unit, Department of Medicine, University of Padua, ItalyDepartment of Electrical, Computer and Biomedical Engineering, University of Pavia, ItalyDepartment of Electrical, Computer and Biomedical Engineering, University of Pavia, ItalyDepartment of Medicine and Surgery, University Milano Bicocca, Milan, Italy; Nephrology Unit, IRCCS Fondazione San Gerardo dei Tintori, Monza, ItalyDepartment of Medicine and Surgery, University Milano Bicocca, Milan, Italy; Nephrology Unit, IRCCS Fondazione San Gerardo dei Tintori, Monza, ItalyDepartment of Medicine and Surgery, Pathology, University Milano-Bicocca, IRCCS Fondazione San Gerardo dei Tintori, Monza, ItalyNephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, ItalyDepartment of Statistical Sciences, University of Padova, Padova, ItalyRheumatology Unit, Department of Medicine, University of Padua, ItalyRheumatology Unit, Department of Medicine, University of Padua, ItalyNephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Rozzano, Milan, ItalyRheumatology Unit, Department of Medicine, University of Padua, ItalyNephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy; Correspondence: Gabriella Moroni, Nephrological Unit, IRCCS Humanitas Research Hospital, Department of Biomedical Sciences Humanitas University, Via Rita Levi Montalcini,4; 20072 Pieve Emanuele Milan, Italy.Introduction: This retrospective study on patients with biopsy-proven lupus nephritis (LN) aimed to assess the probability of sustained clinical remission (sCR) and to investigate sCR effects on disease flares and impaired kidney function (IKF). Methods: sCR was defined as clinical-Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) = 0 and estimated glomerular filtration rate (eGFR) >60 ml/min per 1.73 m2 lasting ≥1 year; IKF: eGFR <60 ml/min per 1.73 m2 for >3 months. We analyzed the probability of achieving and maintaining sCR, and the yearly risk of flare. Cox models were used to identify predictors of sCR and IKF with variables analyzed as time-dependent covariates when appropriate. Results: Of 303 patients followed-up with for 14.8 (interquartile range: 9.8–22) years, 257 (84.8%) achieved sCR. The probability of achieving sCR progressively increased over time reaching 90% at 15 years. Baseline age (hazard ratio [HR]: 1.017; 95% confidence interval [CI]: 0.005–1.029; P = 0.004), hydroxychloroquine intake (HR: 1.385; 95% CI: 1.051–1.825; P = 0.021), and absence of arterial hypertension (HR: 0.699; 95% CI: 0.532–0.921; P = 0.011) were independent predictors of sCR. Among patients who achieved sCR, 142 (55.3%) developed a lupus flare after a median time of 3.6 (2.3–5.9) years. In the remaining 115 patients, sCR persisted for 9.5 (5.8–14.5) years. The probability of sCR to persist at 15 years was 38%. SLE flare risk decreased to 10%, 5%, and 2% in patients with sCR lasting <5, 5 to 10, and >10 years, respectively. At the last observation, 57 patients (18.81%) had IKF. sCR achievement (HR: 0.18, P < 0.001) and its duration (HR: 0.83, P < 0.001) were protective against IKF. Conclusion: sCR is an achievable target in LN management and protects against IKF. The longer the sCR, the higher the chance of its persistence and the lower the risk of SLE flares.http://www.sciencedirect.com/science/article/pii/S2468024924000172impaired kidney functionlupus flareslupus nephritisremissionsustained clinical remission |
| spellingShingle | Mariele Gatto Giulia Frontini Marta Calatroni Francesco Reggiani Roberto Depascale Claudio Cruciani Silvana Quaglini Lucia Sacchi Barbara Trezzi Grazia Dea Bonelli Vincenzo L'Imperio Augusto Vaglio Claudia Furlan Margherita Zen Luca Iaccarino Renato Alberto Sinico Andrea Doria Gabriella Moroni Effect of Sustained Clinical Remission on the Risk of Lupus Flares and Impaired Kidney Function in Patients With Lupus Nephritis Kidney International Reports impaired kidney function lupus flares lupus nephritis remission sustained clinical remission |
| title | Effect of Sustained Clinical Remission on the Risk of Lupus Flares and Impaired Kidney Function in Patients With Lupus Nephritis |
| title_full | Effect of Sustained Clinical Remission on the Risk of Lupus Flares and Impaired Kidney Function in Patients With Lupus Nephritis |
| title_fullStr | Effect of Sustained Clinical Remission on the Risk of Lupus Flares and Impaired Kidney Function in Patients With Lupus Nephritis |
| title_full_unstemmed | Effect of Sustained Clinical Remission on the Risk of Lupus Flares and Impaired Kidney Function in Patients With Lupus Nephritis |
| title_short | Effect of Sustained Clinical Remission on the Risk of Lupus Flares and Impaired Kidney Function in Patients With Lupus Nephritis |
| title_sort | effect of sustained clinical remission on the risk of lupus flares and impaired kidney function in patients with lupus nephritis |
| topic | impaired kidney function lupus flares lupus nephritis remission sustained clinical remission |
| url | http://www.sciencedirect.com/science/article/pii/S2468024924000172 |
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