Arthur Mageau1, Jean-François Timsit2, Anne Perrozziello3, Stéphane Ruckly3, Claire Dupuis3, Lila Bouadma2, Thomas Papo4, Karim Sacre5. 1. IAME UMR1137, Equipe 5 DeScID, Université Paris-Diderot, Paris, France; Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France. 2. IAME UMR1137, Equipe 5 DeScID, Université Paris-Diderot, Paris, France; Département de Réanimation Médicale, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France. 3. IAME UMR1137, Equipe 5 DeScID, Université Paris-Diderot, Paris, France. 4. Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France; INSERM U1149, Université Paris-Diderot, Paris, France. 5. Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France; INSERM U1149, Université Paris-Diderot, Paris, France. Electronic address: karim.sacre@aphp.fr.
Abstract
OBJECTIVE: To analyze the impact of chronic kidney disease (CKD) on major clinical outcome in SLE by using a nationwide database. PATIENTS AND METHODS: Characteristics of all admitted SLE patients experiencing CKD (eGFR <60 mL/min/1.73 m2) 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, 6439 (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 6439 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.
OBJECTIVE: To analyze the impact of chronic kidney disease (CKD) on major clinical outcome in SLE by using a nationwide database. PATIENTS AND METHODS: Characteristics of all admitted SLEpatients experiencing CKD (eGFR <60 mL/min/1.73 m2) 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 SLEpatients were hospitalized in France. Among them, 6439 (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 6439 SLEpatients. 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 SLEpatients, highlighting the need for early pre-CKD lupus nephritis diagnosis and treatment.
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Authors: Ze Xiu Xiao; Xiaojiang Hu; Ximei Zhang; Zhigang Chen; Julie Wang; Ke Jin; Feng Lin Cao; Baoqing Sun; Joseph A Bellanti; Nancy Olsen; Song Guo Zheng Journal: Signal Transduct Target Ther Date: 2020-04-10