Article Figures & Data
Tables
Patients, N = 436 P Age, yrs 58.5 ± 13.4 Sex, male 109 (25) Disease duration, yrs 7.7 ± 5.3 BMI, kg/m2 23.5 ± 3.8 BSA, m2 1.6 ± 0.2 Comorbidities DM 62 (14.2) HTN 146 (33.5) Dyslipidemia 62 (14.2) Smoking 32 (7.3) Medications administered MTX / mean dose per wk, mg 436 (100) / 11.8 ± 3.3 LEF 212 (48.6) SSZ 179 (41) HCQ 172 (39.4) Tacrolimus 107 (24.5) GC 331 (75.9) NSAID 182 (41.7) bDMARD 47 (10.8) tsDMARD 18 (4.1) ACEi or ARB 52 (11.9) Gastric acid secretion inhibitor or prokinetic agent 143 (32.7) RF positivity 334 (76.6) ACPA positivity 349 (80) Initial SCr, mg/dL 0.68 ± 0.16 Cystatin C, mg/L 0.98 ± 0.36 eGFR equation < 0.01 CKD-EPISCr, mL/min/1.73 m2 95.55 ± 18.09 CKD-EPIcys, mL/min/1.73 m2 89.44 ± 23.91 Data are presented as mean ± SD or n (%). Values in bold are statistically significant. ACEi: angiotensin-converting enzyme inhibitor; ACPA: anticitrullinated protein antibody; ARB: angiotensin receptor blocker; bDMARD: biologic disease-modifying antirheumatic drug; BSA: body surface area; CKD-EPI: chronic kidney disease epidemiology collaboration; cys: cystatin C; DM: diabetes mellitus; DMARD: disease-modifying antirheumatic drug; eGFR: estimated glomerular filtration rate; GC: glucocorticoid; HCQ: hydroxychloroquine; HTN: hypertension; LEF: leflunomide; MTX: methotrexate; NSAID: nonsteroidal antiinflammatory drug; RA: rheumatoid arthritis; RF: rheumatoid factor; SCr: serum creatinine; SSZ: sulfasalazine; tsDMARD: targeted synthetic disease-modifying antirheumatic drug.
Stage According to the KDIGO Guideline CKD-EPISCr,
N = 436CKD-EPIcys,
N = 436P 1 312 (71.5) 249 (57.1) < 0.01 2 102 (23.4) 134 (30.7) 0.02 3A 16 (3.7) 22 (5) 0.32 3B 5 (1.1) 19 (4.4) < 0.01 4 1 (0.02) 11 (2.5) < 0.01 5 0 (0) 1 (0.02) > 0.99 Data are presented as n (%). Values in bold are statistically significant. CKD-EPI: chronic kidney disease epidemiology collaboration; cys: cystatin C; KDIGO: Kidney Disease: Improving Global Outcomes; SCr: serum creatinine.
- Table 3.
Changes of KDIGO and MTX dosing guideline stage using CKD-EPISCr and CKD-EPIcys equations.
A. Change of KDIGO stage using CKD-EPISCr and CKD-EPIcys equations. Stage CKD-EPIcys 1, n = 249 2, n = 134 3A, n = 22 3B, n = 19 4, n = 11 5, n = 1 CKD-EPISCr 1, n = 312 233 78 1 0 0 0 2, n = 102 16 55 21 9 1 0 3A, n = 16 0 1 0 9 6 0 3B, n = 5 0 0 0 1 4 0 4, n = 1 0 0 0 0 0 1 5, n = 0 0 0 0 0 0 0 B. Change of MTX dosing guideline stage using CKD-EPISCr and CKD-EPIcys equations. eGFR, mL/min/1.73 m2 CKD-EPIcys < 10, n = 0 10-50, n = 38 > 50, n = 398 CKD-EPISCr < 10, n = 0 0 0 0 10-50, n = 11 0 11 0 > 50, n = 425 0 27 398 Values are n. Light gray and dark gray cells indicate change of classification to upward and downward stages, respectively. CKD-EPI: chronic kidney disease epidemiology collaboration; cys: cystatin C; eGFR: estimated glomerular filtration rate; KDIGO: Kidney Disease: Improving Global Outcomes; MTX: methotrexate; SCr: serum creatinine.
Univariable Analysis Multivariable Analysisa OR 95% CI P OR 95% CI P Age, yrs 1.05 1.02-1.07 < 0.01 1.05 1.03-1.08 < 0.01 Male sex 1.31 0.73-2.36 0.36 Disease duration, yrs 1.03 0.98-1.08 0.22 BMI, kg/m2 1.05 0.98-1.12 0.16 DM 1.95 1.03-3.69 0.04 2.03 1.12-3.67 0.02 HTN 1.84 1.08-3.10 0.03 1.94 1.19-3.16 0.01 Dyslipidemia 0.73 0.37-1.42 0.35 Smoking 2.02 0.83-4.89 0.12 MTX dose 0.97 0.90-1.04 0.39 LEF 2.24 1.34-3.74 < 0.01 1.92 1.22-3.04 0.01 SSZ 0.91 0.54-1.52 0.71 HCQ 0.80 0.48-1.35 0.41 Tacrolimus 1.23 0.71-2.16 0.46 NSAID 0.67 0.40-1.11 0.12 tsDMARD 0.74 0.18-3.02 0.67 ACEi or ARB 1.29 0.70-2.37 0.42 RF positivity 1.14 0.61-2.12 0.69 ACPA positivity 0.78 0.41-1.51 0.47 ESR 1.00 0.99-1.02 0.97 Values in bold are statistically significant.
↵a Only statistically significant variables from the univariable analysis were used in the multivariable analysis. ACEi: angiotensin-converting enzyme inhibitor; ACPA: anticitrullinated peptide antibody; ARB: angiotensin receptor blocker; DM: diabetes mellitus; ESR: erythrocyte sedimentation rate; HCQ: hydroxychloroquine; HTN: hypertension; LEF: leflunomide; MTX: methotrexate; NSAID: nonsteroidal antiinflammatory drug; OR: odds ratio; RF: rheumatoid factor; SSZ: sulfasalazine; tsDMARD: targeted synthetic disease-modifying antirheumatic drug.
- Table 5.
Comparison of MTX-associated toxicities between the stage-changed and nonstage-changed groups.
MTX-associated Toxicity, n Stage-changed
Group, n = 130Nonstage-changed
Group, n = 306P Total events, n = 103 40 (30.7) 63 (20.6) 0.02 Alopecia, n = 6 1 (0.8) 5 (1.6) 0.48 Anemia, n = 6 4 (3.1) 2 (0.6) 0.04 Flushing, n = 1 1 (0.8) 0 (0) 0.13 Headache, n = 1 1 (0.8) 0 (0) 0.13 Hepatotoxicity, n = 25 11 (8.5) 14 (4.6) 0.11 All respiratory events assumed to be related to MTX, n = 5 2 (1.5) 3 (1) 0.62 Serious Infection, n = 3 1 (0.8) 2 (0.6) 0.89 Leukopenia, n = 9 6 (4.6) 3 (0.9) 0.02 Malignancy, n = 3 0 (0) 3 (0.9) 0.26 GI symptoms, n = 31 5 (3.8) 26 (8.5) 0.08 Nephrotoxicity n = 5 4 (3.1) 1 (0.3) 0.01 Stomatitis, n = 4 2 (1.5) 2 (0.6) 0.38 Thrombocytopenia, n = 4 2 (1.5) 2 (0.6) 0.38 Data are presented as n (%). Values in bold are statistically significant. GI: gastrointestinal; MTX: methotrexate.
