Survival analysis and causes of mortality in patients with lupus nephritis

• Published in: Nephrology, dialysis, transplantation Vol. 27; no. 8; pp. 3248 - 3254
• Main Authors: YAP, Desmond YH, TANG, Colin S. O, MA, Maggie K. M, MAN FAI LAM, TAK MAO CHAN
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-08-2012
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cause of Death; China - epidemiology; Emergency and intensive care: renal failure. Dialysis management; Female; Follow-Up Studies; Humans; Intensive care medicine; Kaplan-Meier Estimate; Kidney Failure, Chronic - etiology; Kidney Failure, Chronic - mortality; Lupus Nephritis - complications; Lupus Nephritis - mortality; Male; Medical sciences; Middle Aged; Retrospective Studies; Risk Factors; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Survival Analysis; Young Adult; China; Human; Kidney disease; Immunopathology; Connective tissue disease; Skin disease; Urinary system disease; Hemodialysis; Mortality; Autoimmune disease; Terminal stage; end-stage renal disease; Survival; Extrarenal dialysis; systemic lupus erythematosus; Systemic disease; Risk factor; Renal failure; Lupus erythematosus; lupus nephritis
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfs073

This study aimed to define the causes and associated risks of death compared with the local general population in Chinese patients with lupus nephritis in the recent era.
The records of all lupus nephritis patients followed in a single centre during 1968-2008 were reviewed. The causes of death were identified, the survival curves constructed and the standardized mortality ratios (SMRs) of potential risk factors were calculated with reference to the local general population.
Two hundred and thirty systemic lupus erythematosus patients with history of renal involvement (predominantly Class III/IV lupus nephritis with or without membranous features) were included. The follow-up was 4076.6 person-years (mean 17.7 ± 8.9 years). Twenty-four patients (10.4%) died, and 85% of the deaths occurred after 10 years of follow-up. The 5-, 10-, and 20-year survival rates were 98.6, 98.2 and 90.5%, respectively. The leading causes of death were infection (50.0%), cardiovascular disease (20.8%) and malignancy (12.5%). The renal survival rates at 5, 10 and 20 years were 99.5, 98.0 and 89.7%, respectively. The SMR in patients with renal involvement, end-stage renal disease (ESRD), malignancy or cardiovascular disease was 5.9, 26.1, 12.9 and 13.6, respectively.
Lupus nephritis is associated with a 6-fold increase in mortality compared with the general population. Lupus patients who develop ESRD have a 26-fold excess in the risk of death, which is more than twice the risk associated with malignancy or cardiovascular disease in these patients.