Survival analysis and causes of mortality in patients with lupus nephritis

Yap, Desmond Y H; Tang, Chun-Lei; K.M., Maggie; Lam, Man Fai; Chan, Tak Mao

doi:10.1093/ndt/gfs073

Cited by 253 publications

(228 citation statements)

References 39 publications

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“…In the latter group, there was no tumor recurrence after a follow-up of 54.0 ± 16.9 months. In this regard, increased long-term risk of malignancy had been reported in LN patients and was associated with excessive mortality [1,32,33]. Data from organ transplant recipients shows that long-term immunosuppressive regimens that include mTOR inhibitors are associated with reduced overall cancer risk when compared to patients not treated with mTOR inhibitors, and the difference is due to a lower incidence of non-melanoma skin cancers and kidney cancers [13,34,35].…”

Section: Discussionmentioning

confidence: 99%

“…Lupus nephritis (LN) is a serious organ involvement in patients with systemic lupus erythematosus (SLE), and is associated with excessive patient mortality [1,2]. LN can occur in approximately 50% of Caucasian SLE patients, and up to 60-70% in Asian SLE patients [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

“…LN can occur in approximately 50% of Caucasian SLE patients, and up to 60-70% in Asian SLE patients [1][2][3]. The disease course of LN is characterized by episodes of active renal flares intercalated with periods of disease quiescence.…”

Section: Introductionmentioning

confidence: 99%

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WITHDRAWN: Long-term data on sirolimus treatment in patients with lupus nephritis

Yap¹,

Tang²,

Chan³

et al. 2018

Oncotarget

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Our pilot short-term data suggested efficacy of sirolimus treatment in lupus nephritis (LN) patients, but its long-term data remains limited. We retrospectively reviewed 16 Class III/IV/V LN patients who have received prednisolone and sirolimus either as initial or maintenance treatment. Sixteen patients received sirolimus treatment (9 due to intolerance to standard immunosuppressants and 7 due to a history of malignancy) for 45.3 ± 36.5 months. In five patients sirolimus and prednisolone was given as induction for active nephritis, and they showed improvements in proteinuria (2.8 ± 1.9 g/day at baseline, 0.1 ± 0.1 g/day after 36 months, p = 0.011), anti-dsDNA (107.7 ± 91.9 IU/mL and 37.0 ± 55.4 IU/mL respectively, p = 0.178) and C3 (54.8 ± 26.1 mg/dL and 86.3 ± 18.6 mg/dL respectively, p = 0.081). Eleven patients received sirolimus and low-dose prednisolone as long-term maintenance, and they showed continued improvement in C3 (90.4 ± 18.1 mg/dL and 117.7±25.1 mg/dL at commencement and after 36 months respectively, p = 0.025) and stable renal function (eGFR 58.6 ± 25.8 ml/min and 63.0 ± 29.6 mL/min respectively, p = 0.239) and proteinuria (0.8 ± 0.7 g/day and 0.7 ± 0.7 g/day respectively, p = 0.252). Renal flare occurred in one patient and another patient with Stage 4 chronic kidney disease when sirolimus was started developed endstage renal failure after 27 months. Sirolimus was discontinued in five patients, in four cases related to drug sideeffects. Deterioration of dyslipidaemia occurred in four patients, but was adequately controlled with statin therapy. The preliminary evidence suggests that sirolimus may serve as an alternative treatment for LN who do not tolerate standard treatment or had history of malignancy, and with acceptable long-term safety profile.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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WITHDRAWN: Long-term data on sirolimus treatment in patients with lupus nephritis

Yap¹,

Tang²,

Chan³

et al. 2018

Oncotarget

View full text Add to dashboard Cite

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“…Treatment of patients with ESRD caused by GN incurs an estimated annual cost to Medicare alone of almost $3 billion (1). Mortality in GN increases dramatically after the onset of ESRD (2)(3)(4)(5); however, the relative contributions from generic ESRD-related factors and from the underlying cause of GN to this finding have not formally been evaluated.…”

Section: Introductionmentioning

confidence: 99%

Patient Characteristics and Outcomes by GN Subtype in ESRD

O’Shaughnessy

Montez‐Rath

Lafayette

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Outcomes-based research rarely focuses on patients with ESRD caused by GN. The hypotheses were that the GN subtype would clinically discriminate patient groups and independently associate with survival after ESRD therapy initiation.Design, setting, participants, & measurements Data were extracted from the US Renal Data System for adult patients with incident (1996-2011) ESRD attributed to six GN subtypes: FSGS, IgA nephropathy (IgAN), membranous nephropathy, membranoproliferative glomeruonephritis, lupus nephritis (LN), and vasculitis. ESRD attributed to diabetes and autosomal dominant polycystic kidney disease served as non-GN comparators. Unadjusted and adjusted mortality hazard ratios (aHRs) with 95% confidence intervals (95% CIs) were estimated using Cox regression (reference, IgAN). Models sequentially adjusted for sociodemographic (model 2), comorbidity/laboratory (model 3), and ESRD treatment modality (model 4) variables.Results Among 84,301 patients with ESRD attributed to GN, the median age ranged from 39 (LN) to 66 (vasculitis) years, male sex ranged from 18% (LN) to 68% (IgAN), and black race ranged from 7% (IgAN) to 49% (LN). Patients with IgAN had the fewest comorbidities and lowest use of hemodialysis (70.1%). After a median followup of 2.5 (interquartile range, 1.0-4.9) years, crude mortality was lowest in IgAN (3.7 deaths/100 person years). Compared to IgAN, adjusted mortality was highest in LN (model 4 aHR=1.75; 95% CI, 1.68 to 1.83) and in diabetes (aHR=1.73; 95% CI, 1.67 to 1.79), and was also higher in all other GN subtypes (membranous nephropathy: aHR=1.23; 95% CI, 1.17 to 1.29; FSGS: aHR=1.37; 95% CI, 1.32 to 1.42; membranoproliferative GN: aHR=1.38; 95% CI, 1.31 to 1.45; vasculitis: aHR=1.51; 95% CI, 1.45 to 1.58) and in autosomal dominant polycystic kidney disease (aHR=1.22; 95% CI, 1.18 to 1.27).Conclusions This study exposes substantial heterogeneity across GN subtypes at ESRD therapy initiation and identifies independent associations between GN subtype and post-ESRD mortality. These survival discrepancies warrant further study, and the utility of current research practice to group GN subtypes together when evaluating ESRD outcomes should be questioned.

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“…These drugs for LN are usually selected based on findings of renal biopsy [2]. Yap et al [3] reported that LN was associated with a 6-fold increase in mortality compared with the general population and major causes of death were infection, cardiovascular disease, and malignancy. Kidney biopsy is considered as a gold standard for diagnosing, classifying, and guiding the treatment of LN.…”

Section: Is Urinary Tumor Necrosis Factor-like Weak Inducer Of Apoptomentioning

confidence: 99%

Is Urinary Tumor Necrosis Factor-like Weak Inducer of Apoptosis a Biomarker of Lupus Nephritis?

Min

2017

J Rheum Dis

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Survival analysis and causes of mortality in patients with lupus nephritis

Abstract: 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.

Cited by 253 publications

References 39 publications

WITHDRAWN: Long-term data on sirolimus treatment in patients with lupus nephritis

WITHDRAWN: Long-term data on sirolimus treatment in patients with lupus nephritis

Patient Characteristics and Outcomes by GN Subtype in ESRD

Is Urinary Tumor Necrosis Factor-like Weak Inducer of Apoptosis a Biomarker of Lupus Nephritis?

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