Hanaoka Hironari, Kikuchi Jun, Hiramoto Kazuoto, Saito Shuntaro, Kondo Yasushi, Kaneko Yuko
Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Clin Kidney J. 2022 Jan 31;15(7):1373-1378. doi: 10.1093/ckj/sfac036. eCollection 2022 Jul.
We investigated the incidence of chronic kidney disease (CKD) progression and its factors relevant to patients with stable rheumatoid arthritis (RA).
We enrolled consecutive patients with RA who had initiated treatment with a biologic disease-modifying anti-rheumatic drug (bDMARD) at our institution and continued the same drug for >5 years between 2001 and 2016. Patients with CKD at bDMARD initiation were excluded. C-reactive protein (CRP) level, Clinical Disease Activity Index (CDAI) score and estimated glomerular filtration rate were measured every 6 months.
We included 423 patients, with 196 on tumour necrosis factor inhibitors, 190 on tocilizumab and 37 on abatacept. Among these patients, 34 (8.0%) progressed to CKD within 5 years. The mean CRP level and CDAI score over 5 years were significantly lower in patients without CKD progression than in those with CKD progression ( < .001 and = .008, respectively). Multivariable analysis revealed that age at bDMARD initiation [odds ratio (OR) 1.05, = .002], non-steroidal anti-inflammatory drug use (OR 3.47, = .004) and mean CRP >0.14 mg/dL (OR 5.89, = .015) were independently associated with CKD progression, while tocilizumab use was associated with a decreased risk of CKD progression (OR 0.31, = .027).
Controlling inflammation contributes to the inhibition of CKD progression in RA patients.
我们调查了慢性肾脏病（CKD）进展的发生率及其与稳定期类风湿关节炎（RA）患者相关的因素。
我们纳入了在本机构开始使用生物改善病情抗风湿药物（bDMARD）治疗并在2001年至2016年间持续使用同一药物超过5年的连续RA患者。排除在开始使用bDMARD时即患有CKD的患者。每6个月测量一次C反应蛋白（CRP）水平、临床疾病活动指数（CDAI）评分和估计肾小球滤过率。
我们纳入了423例患者，其中196例使用肿瘤坏死因子抑制剂，190例使用托珠单抗，37例使用阿巴西普。在这些患者中，34例（8.0%）在5年内进展为CKD。无CKD进展患者5年期间的平均CRP水平和CDAI评分显著低于有CKD进展的患者（分别为P<0.001和P = 0.008）。多变量分析显示，开始使用bDMARD时的年龄[比值比（OR）1.05，P = 0.002]、使用非甾体抗炎药（OR 3.47，P = 0.004）和平均CRP>0.14 mg/dL（OR 5.89，P = 0.015）与CKD进展独立相关，而使用托珠单抗与CKD进展风险降低相关（OR 0.31，P = 0.027）。
控制炎症有助于抑制RA患者的CKD进展。
