Background Lupus nephritis is a critical manifestation of systemic lupus erythematosus. It would progress to end stage renal disease (ESRD) if no appropriate treatment or refractory to clinical management.
Objectives The predictors of ESRD progression were rarely been explored in Asian populations. The aim of this study was to investigate the factors affecting outcome in Taiwanese patients with lupus nephritis and to identify groups of patients with a high risk which need aggressive treatment.
Methods We conducted a nationwide cohort study of the risk factors of ESRD among 2073 patients who had the history of lupus nephritis, using the National Health Insurance database of Taiwan from 1997 to 2009. Hazzard ratios (HRs) of predictors of ESRD development in lupus nephritis were analyzed.
Results Among the patients with lupus nephritis, 19.3% patients developed ESRD within 10 years follow up, of which 48.6% patients developed within 5 years. The incidence rate of ESRD development decreased from 1997 to 2009 in Taiwan. The 10 year survival rate in patients with and without ESRD was 71.9% and 85.9% respectively. Age of less than 20 years old (HR 1.37, 95% CI 1.09-1.72) and concomitant hypertension (HR 1.33, 95% CI 1.02-1.74) was found to be independent risk factors for the development of ESRD. Patients with the history of receiving renal biopsy had a significantly decreased risk of ESRD (HR 0.708, 95% CI 0.56-0.89).
Conclusions The lupus nephritis patients with ESRD had a decreased survival rate. The lupus nephritis patients which were younger than 20 years old and have the comorbidity of hypertension have an increased risk of ESRD development. Clinical management should be aggressive to avoid ESRD progression. Anti-hypertension treatment and renal biopsy if necessary should be recommended in those patients with high risks.
Disclosure of Interest : None declared