O44 Long-term outcomes of chronic kidney disease patients with lupus nephritis: a nationwide cohort study

Objective To explore the long-term outcomes of patients with chronic kidney disease (CKD) due to Lupus Nephritis (LN), as compared to CKD of other etiologies. Methods Using data extracted from the Swedish Renal Registry (2006–2021), we compared clinical outcomes between: 1) CKD related to LN (LN-CKD); 2) CKD related to primary glomerular diseases PGD-CKD, i.e. IgA nephropathy, focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MN); 3) CKD related to other causes (Other-CKD, mostly diabetes and nephrosclerosis). Cox proportional hazard models were used to estimate adjusted hazard ratios of mortality, major cardiovascular events (MACE) and kidney replacement therapy (KRT). Results At baseline, LN-CKD (N=317, 61 years, 76% females, mean eGFR 38.7 mL/min per 1.73 m2) and PGD-CKD (N=2296, 57 years, 69% males, mean eGFR 36.5 mL/min per 1.73 m2) had a lower prevalence of cardiovascular disease than the Other-CKD (N=34778, 75 years, 64% males, mean eGFR 26.5 mL/min per 1.73 m2). Over a median follow-up of 6.2 3.3;9.8 years, 19029 deaths (51%), 15768 (42%) MACE and 8390 (22%) KRT events occurred. The unadjusted 5-year- absolute risks of death and MACE were high both in LN-CKD (27% and 25%) and Other-CKD (50% and 44%), but lower in PGD-CKD (16% and 14%), whereas the 5-year- risk for KRT was higher in PGD (PGD-CKD: 37%, LN-CKD: 23%, Other-CKD: 23%). In the multivariable analyses, as compared to PGD-CKD, the risks of death and MACE were higher in patients with LN-CKD (HR: 1.63 95%CI: 1.32–2.02 for death, HR: 1.65 1.31–2.08 for MACE) and Other-CKD (HR: 1.67 1.52–1.84 for death, HR: 1.76 1.58–1.96 for MACE). In contrast, the risk for KRT was lower both in patients with LN-CKD (HR: 0.81 0.64–1.02 although 95%CI slightly overlaps) and in the Other-CKD group (HR: 0.84 0.78–0.91) (figure 1). Conclusion While LN-CKD had a lower risk for KRT than PGD-CKD, exhibited higher risk for MACE and death, reaching the risk magnitude of older patients with high cardiovascular burden (Other-CKD). This highlights the need for cardiovascular prevention in LN, especially in moderate to advanced CKD.