Evolution of chronic kidney disease in patients with systemic lupus erythematosus over a long-period follow-up: a single-center inception cohort study
Evolution of chronic kidney disease in patients with systemic lupus erythematosus over a long-period follow-up: a single-center inception cohort study
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DOI：
10.1007/s10067-014-2527-0
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发表时间：
2014-05-01
影响因子：
3.4
通讯作者：
Molad, Yair
中科院分区：
文献类型：
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作者：
Pokroy-Shapira, Elisheva;Gelernter, Ilana;Molad, Yair
本研究的目的是探讨在一个三级中心随访的系统性红斑狼疮（SLE）患者的初始队列中慢性肾脏病（CKD）的发生率和危险因素。前瞻性收集了256例连续SLE患者的数据库，随访超过25年，对人口统计学、疾病表现、合并症和结局进行了系统性询问。在第一次和最后一次研究访视时测定标准化SLE活动和损伤评分，并在诊断时和每年随访时计算估计的肾小球滤过率（eGFR; MDRD公式）。CKD定义为eGFR < 60 ml/min/1.73 m2。采用单变量和多变量模型以及Kaplan-Meier曲线（如适用）分析结果。该队列主要为女性（90%）和犹太人（91.1%）。诊断时的平均年龄为38 ± 15.5岁，平均SLE活动评分为6.4 ± 3.8，平均疾病持续时间为8.8 ± 6.6年，平均损伤评分为0.2 ± 0.6。在研究期间，75例患者（30.8%）被诊断为美国风湿病学会（ACR）定义的狼疮性肾病。eGFR随时间进行性降低。CKD的患病率在患有ACR定义的肾脏狼疮疾病的患者中为46.7%，而在未患有ACR定义的肾脏狼疮疾病的患者中为16.4%。有狼疮性肾炎（LN）的患者CKD的风险比显著高于无狼疮性肾炎的患者（p < 0.001）。早期CKD与高血压（p = 0.01）、诊断时年龄较大（p = 0.01）和LN（p < 0.001）呈正相关，与羟氯喹治疗呈负相关（p < 0.001）。CKD的患病率在SLE患者中累积增加，在没有明显狼疮性肾病的患者中也是如此。狼疮性肾脏疾病对早期CKD的发展构成重大危险，高血压是有和无肾炎患者的主要危险因素。抗疟治疗仅与狼疮性肾炎患者的肾脏保护有关。
The objective is to investigate the accrual rate and risk factors of chronic kidney disease (CKD) in an inception cohort of patients with systemic lupus erythematosus (SLE) followed at a single tertiary center. A prospectively collected database of 256 consecutive patients with SLE followed over a 25-year period was systematically interrogated for demographic, disease manifestations, co-morbidities, and outcome. Standardized SLE activity and damage scores were determined for the first and last study visits, and estimated glomerular filtration rate (eGFR; MDRD formula) was calculated at the time of diagnosis and at each year of the follow-up. CKD was defined as eGFR < 60 ml/min/1.73 m(2). Results were analyzed with univariate and multivariate models and Kaplan-Meier curves, as appropriate. The cohort was predominantly female (90 %) and Jewish (91.1 %). Mean age at diagnosis was 38 +/- 15.5 years, mean SLE activity score 6.4 +/- 3.8, mean disease duration 8.8 +/- 6.6 years, and mean damage score 0.2 +/- 0.6. Seventy-five patients (30.8 %) were diagnosed with American College of Rheumatology (ACR)-defined lupus renal disease during the study period. There was a progressive decrease in eGFR over time. The prevalence of CKD was 46.7 % in patients with ACR-defined renal lupus disease and 16.4 % in those without. The hazards ratio for CKD was significantly higher in patients with lupus nephritis (LN) than without (p < 0.001). Earlier CKD was positively associated with hypertension (p = 0.01), older age at diagnosis (p = 0.01), and LN (p < 0.001), and negatively associated with hydroxychloroquine treatment (p < 0.001). The prevalence of CKD increases cumulatively in patients with SLE, also in those without overt lupus renal disease. Lupus renal disease poses a significant hazard for earlier development of CKD, and hypertension is a major risk factor for patients with and without nephritis. Antimalarial treatment is associated with renal preservation only in patients with lupus nephritis.