Prevalence of Renal Impairment in Patients With Rheumatoid Arthritis: Results From a Cross‐Sectional Multicenter Study

Abstract

Objective. To assess the prevalence and associations of renal dysfunction in patients with rheumatoid arthritis (RA). Methods. COMEDRA is a French nationwide cross-sectional multicenter study on comorbidities in RA. Renal function was assessed from the estimated glomerular filtration rate (eGFR), using the Modification of Diet in Renal Disease equation. RA characteristics and risk factors for renal impairment were collected. Two logistic regression models, 1 with and 1 without the Framingham Risk Score, were constructed from variables that were significantly associated with an eGFR of <60 ml/minute/1.73 m 2 or were clinically relevant. Results. Of the 970 recruited patients, 931 were analyzed (women 79.6%, mean age 57.8 years, disease duration 11.1 years, Disease Activity Score in 28 joints using the erythrocyte sedimentation rate [DAS28-ESR] 3.1). A total of 82 patients (8.8%) had an eGFR <60 ml/minute/1.73 m 2 and 9% had proteinuria. In univariate analysis, renal impairment was associated with age (P < 0.001), history of hypertension (P < 0.001), high systolic blood pressure (P 5 0.03), and the Systematic Coronary Risk Evaluation (SCORE) equation (P 5 0.002), but not with sex, disease duration, disease activity (as assessed by DAS28-ESR), nonsteroidal antiinflammatory drug use, disease severity (erosions, joint replacement), or RA medications. Multivariate analysis models showed that age (odds ratio [OR] 1.05 [95% confidence interval (95% CI) 1.03-1.09]) and hypertension (OR 2.5 [95% CI 1.5-4.3]) were associated with renal impairment. A second model showed that the SCORE equation (OR 1.33 [95% CI 1.06-1.67]) was associated with renal impairment. Conclusion. Renal impairment is relatively common in RA and is associated with cardiovascular risk factors such as age, hypertension, and the SCORE equation but not with disease activity or severity.

Association Between Neutrophils and Renal Impairment of Rheumatoid Arthritis: A Retrospective Cross-sectional Study

“…Chiu et al followed more than 12,000 RA patients for ve years in a cohort study, and they observed that diabetes, hypertension, hyperlipidemia, and cardiovascular disease were related to renal damage [36], which was consistent with the observations of Couderc et al [18] and Vansijl et al [14]. Unfortunately, we failed to nd an independent link between cardiovascular risk factors and kidney damage.…”

“…Another cross-sectional study of 107 RA patients and 76 patients with serum-negative arthritis observed renal impairment (GFR < 60 ml/min /1.73 m 2 ) in 17.48% of the patients with RA [9]. A multicenter cross-sectional survey involving 970 patients in France found that approximately 9% of patients with RA had impaired renal function, indicated by a GFR < 60 ml/min/1.73 m 2 [18].…”

“…Renal impairment, de ned by an estimated glomerular ltration rate (GFR) < 60 ml/minute/1.73 m 2 for at least 3 months [1], was more likely to occur in patients with rheumatoid arthritis (RA) [2]. Previous studies showed that the prevalence of renal damage in RA patients was between 5% and 50% [3,4] in different cohorts.…”

The problem of laboratory monitoring in therapy with disease-modifying antirheumatic drugs and biological agents in patients with rheumatoid arthritis

“…При этом следует учитывать, что оценку риска ССЗ и последующее лечение затрудняет «липидный парадокс», проявляющийся во взаимосвязи выраженного воспаления с уменьшением уровня липидов, правда, далеко не у всех больных [10,11]. Нельзя забывать и о патологии почек, которая наблюдаются у 8-15% больных РА и может нарастать в результате проводимого лечения, наличия амилоидоза или васкулита [12,13]. Однако сегодня практически отсутствуют специфические рекомендации по частоте мониторинга функции почек у больных РА, но имеются указания на необходимость ежегодной оценки уровня креатинина независимо от осуществляемого лечения.…”

“…Однако сегодня практически отсутствуют специфические рекомендации по частоте мониторинга функции почек у больных РА, но имеются указания на необходимость ежегодной оценки уровня креатинина независимо от осуществляемого лечения. [12]. Амилоидоз -одно из наиболее тяжелых осложнений РА, которое наблюдается у 5-19% больных [14].…”