THU0270  THE BURDEN OF CHRONIC KIDNEY DISEASE IN SYSTEMIC LUPUS ERYTHEMATOSUS: A NATIONWIDE EPIDEMIOLOGIC STUDY. (June 2019)

• Record Type: Journal Article
• Authors: Mageau, Arthur; Timsit, Jean-Francois; Perozziello, Anne; Leprieur, Benedicte Giroux; Ruckly, Stephane; Dupuis, Claire; Bouadma, Lila; Papo, Thomas; Sacre, Karim
• Is Part Of: Annals of the rheumatic diseases. Volume 78(2019)Supplement 2
• Page Start: 413
• Page End: 413
• Publication Date: 2019-06
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2019-eular.1359
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Clinical-epidemiological research has advanced our knowledge on the negative impact of lupus nephritis (LN) on systemic lupus erythematosus (SLE) outcomes. Impaired renal function at LN diagnosis and failure to normalize renal function upon aggressive immunosuppressive therapy are associated with a very poor long-term renal outcome. Most reports on that field are however based on tertiary care data of limited sample size that impede the ability to generalize the findings. In order to measure the impact of renal function impairment on clinical outcome such as death or cardiovascular events effectively, updated comprehensive information at national level is needed. Objectives: We conducted an analysis of a French nationwide database to assess the characteristics associated with the presence of CKD (i.e. eGFR <60mL/min/1.73m 2 ) and the prognosis associated with CKD in SLE patients Methods: Characteristics of all admitted SLE patients experiencing CKD in France from 2009 to 2015 were analyzed through the French medico-administrative database. Factors associated with CKD and major clinical outcomes such as end-stage renal disease (ESRD), cardiovascular event (CVE), septic shock and death were assessed. We used a multivariate Cox proportional hazard model and subdistribution hazard models to analyze survival without major clinical events according to the presence of CKD. Results: From 2009 to 2015, 26 320 SLE patients were hospitalized in France. Among them, 6 439 (86.5% women; mean age 45.7 [16.5] years old) had a baseline stay in 2009 during which CKD was reported in 428 (6.7%) cases. Multivariate analysis showed that lupus nephritis (OR 6.6 [5.2-8.4]), high blood pressure (OR 3.5 [2.8-4.5]), septic shock (OR 3.2 [1.7-6.0]) and past cardiovascular history (OR 1.4 [1.0-2.0]) were associated with CKD status. From 2009 to 2015, ESRD, CVE, septic shock, and death occurred in 4.0%, 14.4%, 6.3% and 9.6% of the 6 439 SLE patients. CKD at baseline was independently and strongly associated with the occurrence of ESRD (sdHR 15.9 [11.6-21.9]), CVE (sdHR 1.7 [1.4-2.2]), septic shock (sdHR 2.1 [1.5-2.8]) and death (HR 1.7 [1.3-2.2]) during the follow up Conclusion: CKD is a major risk factor for overall morbidity and mortality in SLE patients, highlighting the need for early pre-CKD lupus nephritis diagnosis and treatment Disclosure of Interests: : Arthur Mageau: None declared, Jean-Francois Timsit: None declared, Anne Perozziello: None declared, Benedicte Giroux Leprieur: None declared, Stephane Ruckly : None declared, Claire Dupuis: None declared, Lila Bouadma: None declared, Thomas Papo: None declared, karim sacre Grant/research support from: GSK