早发性狼疮性肾炎患者终末期肾病的风险：一项基于人群的队列研究。

Risk of end-stage renal disease in patients with early-onset lupus nephritis: A population-based cohort study.

作者信息

Cho Soo-Kyung, Kim Hyoungyoung, Han Jung-Yong, Jeon Yena, Jung Sun-Young, Jang Eun Jin, Sung Yoon-Kyoung

机构信息

Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea; Hanyang University Institute for Rheumatology Research, Seoul, Republic of Korea.

Department of Statistics, Kyungpook National University, Daegu, Republic of Korea.

出版信息

Semin Arthritis Rheum. 2023 Dec;63:152308. doi: 10.1016/j.semarthrit.2023.152308. Epub 2023 Nov 4.

DOI:10.1016/j.semarthrit.2023.152308

PMID:37976812

Abstract

OBJECTIVE

To compare the risk of end-stage renal disease (ESRD) between patients with early-onset lupus nephritis (EOLN) and those with delayed-onset LN (DOLN).

METHODS

This retrospective study of incident cases of systemic lupus erythematosus (SLE) used nationwide Korean claims databases and data from 2008 through 2018. We divided LN patients into two groups: the EOLN group (with LN onset within 12 months of SLE diagnoses) and the DOLN group (with LN onset later than 12 months after SLE diagnoses). Patients were observed from the date of LN diagnosis to the development of ESRD, death, or the last follow-up. Cox proportional hazards modeling was used to predict hazard ratios (HRs) for progression to ESRD with death as a competing risk.

RESULTS

We identified 3779 incident SLE patients who developed LN during follow-up: 60 % (n = 2281) had EOLN, and 40 % (n = 1489) had DOLN. Sixty-nine patients with EOLN (3.0 %) and 29 patients with DOLN (1.9 %) progressed to ESRD. After adjusting for confounders, the ESRD risk associated with EOLN was comparable to the risk associated with DOLN (HR 1.10, 95 % confidence interval [CI] 0.57 to 2.11). In the subgroup of patients on aggressive immunosuppressive therapy (670 with EOLN and 179 with DOLN), the ESRD risk was higher in the DOLN group (HR 2.6, 95 % CI 1.11 to 6.10).

CONCLUSION

The risk of ESRD was comparable between patients with EOLN and DOLN. However, among patients on aggressive immunosuppressive therapy, compared with EOLN, DOLN was associated with a higher risk of progression to ESRD.

摘要

目的

比较早发性狼疮性肾炎（EOLN）患者和迟发性狼疮性肾炎（DOLN）患者发生终末期肾病（ESRD）的风险。

方法

这项对系统性红斑狼疮（SLE）新发病例的回顾性研究使用了韩国全国范围内的索赔数据库以及2008年至2018年的数据。我们将狼疮性肾炎患者分为两组：EOLN组（狼疮性肾炎发病时间在SLE诊断后12个月内）和DOLN组（狼疮性肾炎发病时间在SLE诊断后12个月后）。从狼疮性肾炎诊断之日起观察患者直至发生ESRD、死亡或最后一次随访。采用Cox比例风险模型预测进展为ESRD的风险比（HRs），将死亡作为竞争风险。

结果

我们确定了3779例在随访期间发生狼疮性肾炎的SLE新发病例：60%（n = 2281）为EOLN，40%（n = 1489）为DOLN。69例EOLN患者（3.0%）和29例DOLN患者（1.9%）进展为ESRD。在调整混杂因素后，与EOLN相关的ESRD风险与与DOLN相关的风险相当（HR 1.10，95%置信区间[CI] 0.57至2.11）。在接受积极免疫抑制治疗的患者亚组中（670例EOLN患者和179例DOLN患者），DOLN组的ESRD风险更高（HR 2.6，95%CI 1.11至6.10）。