Is dialysis unavoidable in patients with advanced lupus nephritis-related CKD?

Advanced chronic kidney disease (CKD) associated with lupus nephritis (LN) does not necessarily lead to a need for dialysis, suggests a study, which shows majority of its patients (62 percent) not progressing over 10 year of follow-up on average.

“Advanced CKD carries an increased risk for progression to end-stage renal disease (ESRD),” said the investigators, who sought to determine the progression rate and factors that drove the decline of renal function in LN.

The study included patients with advanced LN-related CKD from a long-term longitudinal cohort. Advanced CKD was characterized by stage 3b (estimated glomerular filtration rate [eGFR], 30–44 ml/min/1.73 m²) and stage 4 (eGFR, 15–29 ml/min/1.73 m²).

The investigators followed all patients until progression to ESRD or the last visit and divided them into “progressors” and “nonprogressors.” They also compared demographic, clinical, immunological, and therapeutic variables at baseline. Predictors for progression were identified by performing multivariable Cox regression analysis (both time-dependent and independent).

Of the 118 patients (74 CKD 3b and 44 CKD 4) included, 45 progressed (29 to ESRD and 16 from CKD 3b to CKD 4) after 6 years on average. Seventy-three patients (nonprogressors) showed no significant decline in renal function after 10 years on average.

Certain predictors for progression to ESRD were also identified. Active serology (high anti-dsDNA titres and low complements C3/C4) at the time of CKD diagnosis and any increase of the daily prednisone dose after baseline showed a robust correlation with progression. On the other hand, treatment with renin angiotensin system blockers correlated with less risk for progression.