Advanced Chronic Kidney Disease in Lupus Nephritis: Is Dialysis Inevitable?

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Advanced chronic kidney disease (CKD) carries an increased risk for progression to end-stage renal disease (ESRD). We aimed to determine the rate of progression and the factors that drive the decline of renal function in lupus nephritis (LN).Patients with advanced LN-related CKD were identified from our longterm longitudinal cohort. Advanced CKD was defined as stage 3b (eGFR=30-44ml/min/1.73m2) and stage 4 (eGFR=15-29ml/min/1.73m2). All individuals were followed until progression to ESRD or the last visit and were divided into "progressors" and "non-progressors". Demographic, clinical, immunological, and therapeutic variables were compared at baseline. Multivariable Cox regression analysis (both time-dependent and independent) was performed to identify predictors for progression.One hundred eighteen patients (74 CKD 3b and 44 CKD 4) were included. Forty-five patients progressed (29 to ESRD and 16 from CKD 3b to CKD 4) after six years on average. No significant decline in the renal function was observed in 73 patients ("non-progressors") after 10 years on average. Active serology (high anti-dsDNA titers and low complements C3/C4) at the time of CKD diagnosis and any increase of the daily prednisone dose after baseline were strongly associated with progression. Treatment with renin angiotensin system (RAS) blockers was associated with less risk for progression.Dialysis is not inevitable in LN-related advanced CKD since 62% of our patients did not progress over 10 years of follow-up on average. Certain predictors were identified to affect progression to ESRD.


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