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Rheumatoid arthritis
Disease activity of rheumatoid arthritis and kidney function decline: a large prospective registry study
  1. Sho Fukui1,2,3,
  2. Wolfgang C Winkelmayer4,
  3. Sara K Tedeschi1,
  4. Javier Marrugo1,
  5. Hongshu Guan1,
  6. Leslie Harrold5,6,
  7. Heather J Litman6,
  8. Tomohiro Shinozaki7,
  9. Daniel H Solomon1
  1. 1Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
  2. 2Department of Emergency and General Medicine, Kyorin University, Tokyo, Japan
  3. 3Immuno-Rheumatology Center, St. Luke’s International Hospital, Tokyo, Japan
  4. 4Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, Texas, USA
  5. 5Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  6. 6CorEvitas LLC, Waltham, Massachusetts, USA
  7. 7Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Katsushika-ku, Tokyo, Japan
  1. Correspondence to Dr Sho Fukui; sfukui{at}bwh.harvard.edu; Professor Daniel H Solomon; dsolomon{at}bwh.harvard.edu

Abstract

Introduction Chronic kidney disease (CKD) is a common comorbidity of rheumatoid arthritis (RA). The association of longitudinal RA disease activity with long-term kidney function has remained uncertain.

Method We analysed a multicentre prospective RA registry in the USA from 2001 to 2022. The exposure was updated time-averaged Clinical Disease Activity Index (TA-CDAI) categories from study enrolment. The primary outcome was a longitudinal estimated glomerular filtration rate (eGFR) change. Secondary outcomes included developments of CKD stage G3a (eGFR<60 mL/min/1.73 m2) and stage G3b (eGFR<45 mL/min/1.73 m2). Results were adjusted for relevant time-fixed and time-varying covariates.

Results 31 129 patients (median age: 58.0 years, female: 76.3%, median eGFR: 90.7 mL/min/1.73 m2) contributed 234 973 visits and 146 778 person-years of follow-up. Multivariable mixed-effect linear model showed an average annual eGFR decline during follow-up in the TA-CDAI-remission group of −0.83 mL/min/1.73 m2 and estimated additional annual declines (95% CI) of –0.09 (–0.15 to –0.03) in low, –0.17 (−0.23 to –0.10) in moderate and −0.18 (–0.27 to –0.08) mL/min/1.73 m2 in high disease activity patients. Compared with TA-CDAI remission, adjusted HRs (95% CI) for CKD stage G3a during follow-up were 1.15 (1.01 to 1.30) in low, 1.22 (1.06 to 1.40) in moderate and 1.27 (1.05 to 1.52) in high disease activity; for CKD stage G3b, 1.22 (0.84 to 1.76) in low, 1.66 (1.12 to 2.45) in moderate and 1.93 (1.16 to 3.20) in high disease activity.

Conclusions Higher RA disease activity was associated with accelerated eGFR decline and increased risk of clinically relevant kidney dysfunction. Future intervention studies should attempt to replicate the association between RA disease activity and eGFR.

  • Rheumatoid Arthritis
  • Epidemiology
  • Arthritis, Rheumatoid
  • Atherosclerosis

Data availability statement

No data are available. Data are not available publicly.

https://doi.org/10.1136/ard-2024-226156

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    Data availability statement

    No data are available. Data are not available publicly.

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    Footnotes

    • Handling editor Josef S Smolen

    • Contributors SF and DHS contributed to the original conception and design of this study, which WCW, SKT, JM, LH, HJL and TS reviewed and corrected. SF and HG collected data. SF performed data analysis with supervision from LH, HJL, TS and DHS. SF, WCW, SKT, JM and DHS initially interpreted the data, and other authors advised on the interpretation. SF drafted the original manuscript, which was critically reviewed and revised by all other authors. All authors have read and approved the final version of the manuscript. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. SF is the guarantor.

    • Funding This study was supported by funding from National Institute of Arthritis and Musculoskeletal and Skin Diseases P30 AR072577 (PI: DHS).

    • Competing interests WCW reports having served as a scientific advisor or consultant to Actos, Akebia, Ardelyx, AstraZeneca, Bayer, Cadrenal, GlaxoSmithKline, Lilly, Merck, Natera, Pharmacosmos, Unicycive, Vera and Zydus. SKT reports consulting fees from Novartis. LH reports employment of CorEvitas, consultant to AbbVie, Bristol Myers Squibb, Pfizer, Roche and speakers bureau for Bristol Myers Squibb. DHS reports salary support through research contracts to his institution from CorEvitas, Janssen and Novartis.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.