Risk of Renal Failure Within 10 or 20 Years of Systemic Lupus Erythematosus Diagnosis

Objective The frequency of endstage renal disease (ESRD) from systemic lupus erythematosus (SLE) in the United States has not improved over the last few decades in large population datasets. Understanding the risk factors for renal failure in SLE could lead to earlier detection of lupus nephritis and potentially more effective treatments in those with markers of poor prognosis.

Methods The Hopkins Lupus Cohort, comprising 2528 patients was used. One hundred fifty-one patients experienced renal failure after SLE diagnosis, defined as dialysis or renal transplant. We estimated the risk of renal failure in subgroups defined by demographics, laboratory tests, and the American College of Rheumatology/Systemic Lupus International Collaborating Clinics (ACR/SLICC) classification criteria satisfied within 1 year of SLE diagnosis.

Results The overall incidence of renal failure within 20 years of SLE diagnosis was 8.4%. The risk was much higher (20.0%) among those who experienced proteinuria within the first year of diagnosis. Demographic predictors included African American ethnicity [rate ratio (RR) 1.82, P = 0.0012] and age ≥ 40 years at SLE diagnosis (RR 0.51 vs those with diagnosis at < 30 yrs of age, P = 0.019). Among immunologic markers, low C3 was a strong predictor of renal failure (RR 2.00, P = 0.0011).

Conclusion Proteinuria within the first year of diagnosis of SLE is one of the most important predictors of ESRD. Our data also confirm African American ethnicity, younger age at SLE diagnosis, and low C3 as strong predictors of renal failure.