Long-term renal outcomes in systemic lupus erythematosus: 10-year experience in a single medical center in Taiwan

Objective: To investigate the clinical characteristics and long-term renal prognosis of lupus-associated nephritis in Taiwan to better understand the presentation of systemic lupus erythematosus (SLE) in Asian populations. Methods. Data from Changhua Christian Hospital Clinical Research Database were retrospectively reviewed from Jan. 2010 until Dec. 2021. Patients diagnosed with SLE were included and categorized depending on their renal involvement. The incidence rate and risk factors of chronic kidney disease (CKD) and end-stage renal disease (ESRD) were analyzed in both groups. Results. A total of 2184 eligible SLE patients were included for analysis. Of those, 293 patients developed renal involvement, with a higher risk of CKD/ESRD development than those without renal involvement. The medium time from renal involvement to CKD and ESRD development was 5.12 (IQR: 0.86–8.54) and 6.19 (IQR: 2.92–9.42) years. The cumulative incidence rate of CKD was 46.6%, 54.5%, and 63%, respectively and that of ESRD was 4%, 7%, and 11% at 1, 2, and 5 years after renal involvement, respectively. Multivariate analysis showed the associated factors for CKD development were renal involvement, age, hypertension, presence of serositis, and use of cyclosporine, steroid, and angiotensin-converting-enzyme inhibitors/angiotensin II receptor blockers, while cyclophosphamide significantly affected ESRD development. Conclusion. In this Taiwanese population, patients with renal involvement were at higher risk to develop CKD than those without renal involvement. Moreover, ESRD development was observed in patients with renal involvement. Further study on this populations and longer follow-up durations are necessary to gain a better understanding of SLE.