Original Investigation
Pathogenesis and Treatment of Kidney Disease
Development of Reduced Kidney Function in Rheumatoid Arthritis

https://doi.org/10.1053/j.ajkd.2013.08.010Get rights and content

Background

Rheumatoid arthritis (RA) is associated with a variety of kidney disorders. However, it is unclear whether the development of reduced kidney function is higher in patients with RA compared to the general population.

Study Design

Retrospective review.

Setting & Participants

Incident adult-onset RA cases (813) and a comparison cohort of non-RA individuals (813) in Olmsted County, MN, in 1980-2007.

Predictor

Baseline demographic and clinical variables.

Outcomes

Reduced kidney function: (1) estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 and (2) eGFR < 45 mL/min/1.73 m2 on 2 consecutive occasions at least 90 days apart; cardiovascular disease (CVD); and death.

Measurements

The cumulative incidence of reduced kidney function was estimated adjusting for the competing risk of death.

Results

Of 813 patients with RA and 813 non-RA individuals, mean age was 56 ± 16 (SD) years, 68% were women, and 9% had reduced kidney function at baseline. The 20-year cumulative incidence of reduced kidney function was higher in patients with RA compared with non-RA participants for eGFR < 60 mL/min/1.73 m2 (25% vs 20%; P = 0.03), but not eGFR < 45 mL/min/1.73 m2 (9% vs 10%; P = 0.8). The presence of CVD at baseline (HR, 1.77; 95% CI, 1.14-2.73; P = 0.01) and elevated erythrocyte sedimentation rate in patients with RA (HR per 10-mm/h increase, 1.08; 95% CI, 1.00-1.16; P = 0.04) was associated with increased risk of eGFR < 60 mL/min/1.73 m2. eGFR < 60 mL/min/1.73 m2 was not associated with increased risk of CVD development in patients with RA (HR, 0.99; 95% CI, 0.63-1.57; P = 0.9), however, a greater reduction in GFR (eGFR < 45 mL/min/1.73 m2) was associated with increased risk of CVD (HR, 1.93; CI, 1.04-3.58; P = 0.04).

Limitations

Reduced kidney function was defined by estimating equations for kidney function. We are limited to deriving associations from our findings.

Conclusions

Patients with RA were more likely to develop reduced kidney function over time. CVD and associated factors appear to play a role. The presence of RA in individuals with reduced kidney function may lead to an increase in morbidity from CVD development, for which awareness may provide a means for optimizing care.

Section snippets

Study Population

An inception cohort of all cases of RA first diagnosed between January 1, 1980, and December 31, 2007 (n = 813), among Olmsted County, MN, residents 18 years or older was assembled as previously described.19 The incidence date was defined as the earliest date at which the patient fulfilled at least 4 of the 7 American College of Rheumatology 1987 classification criteria for RA.20 A comparison cohort of individuals without RA with similar age, sex, and calendar year also was assembled. All

Study Participants

The study population included 813 patients with RA and 813 non-RA individuals. The 2 cohorts had similar characteristics (Table 1). Average age at RA incidence (index date for the non-RA cohort) was 56 ± 16 (SD) years, and 556 (68%) were women. There was a statistically significant difference between smoking status in patients with RA (45% never smokers) compared with individuals in the non-RA cohort (54%). There was no difference in the presence of reduced kidney function at RA incidence/index

Discussion

Patients with RA are more likely to develop reduced kidney function than persons without RA. In our study, at baseline, the prevalence of eGFR < 60 mL/min/1.73 m2 in the cohort groups was ∼9%. Over time, the cumulative incidence of eGFR < 60 mL/min/1.73 m2 in patients with RA reached 15% at 10 years and 25% at 20 years of follow-up, which was close to 5% more than in the non-RA cohort at these times. The rate of development of more advanced kidney disease, eGFR < 45 mL/min/1.73 m2, was similar between

Acknowledgements

Support: This work was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (NIH) (grant R01AR46849) and by the National Institute on Aging of the NIH (grant R01AG034676). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Financial Disclosure: The authors declare that they have no other relevant financial interests.

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