Black Patients With Lupus Nephritis Have Greater Cardiovascular Mortality

Dr Gomez-Puerta MD, PhD, MPH Division of Rheumatology, Immunology, and Allergy; Brigham and Women's Hospital, Harvard Medical School, Boston, MA Medical Research Interview
Dr Gomez-Puerta MD, PhD, MPH
Division of Rheumatology, Immunology, and Allergy; Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Gomez-Puerta: Systemic lupus erythematosus (SLE) is an autoimmune disease of unknown etiology which can cause multiorgan system damage and which disproportionately affects women and non- Caucasian minorities. Up to 60% of SLE patients develop renal disease, lupus nephritis (LN), and of these, approximately one fifth progress to end-stage renal disease (ESRD). The risk of cardiovascular (CV) events and mortality is higher in patients with ESRD and in particular in patients suffering SLE. However, information about CV outcomes and mortality is limited in patients with LN associated ESRD.

We observed important variation in cardiovascular outcomes and mortality by race and ethnicity among lupus nephritis related ESRD patients. After adjusting for multiple demographic and clinical factors and accounting for the competing risk of kidney transplantation and loss to follow-up, our results illustrate for the first time that Asian (vs. White) and Hispanic (vs. non-Hispanic) lupus nephritis related ESRD patients have lower mortality risks.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Gomez-Puerta: Clinicians, especially Rheumatologist and Nephrologist must be aware about differences according race and ethnicity in patients with lupus nephritis with ESRD regarding cardiovascular outcomes. Patients with higher risk, for instances African American and American Native patients should be follow more closely with a tight control of CV risk factors and adequate management of her/his underlying disease (SLE) including immunosuppresive therapy.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Gomez-Puerta: Given the difficult to collect information about patients with lupus nephritis who developed ESRD, We used a National registry of patients with ESRD (U.S. Renal Data System, USRDS). Given the nature of this registry, some relevant clinical and serological data was not available. A prospective multicenter study in a clinical setting will be desirable, including several clinical (disease activity scores and organ damage score) and serological variables in order to identify potential predictors related with different CV outcomes.

Citation:

Racial and ethnic differences in mortality and cardiovascular events among patients with end-stage renal disease due to lupus nephritis

Jose A. Gómez-Puerta Candace H. Feldman1, Graciela S. Alarcón2, Hongshu Guan1, Wolfgang C. Winkelmayer3 and Karen H. Costenbader1

Arthritis Care and Research DOI: 10.1002/acr.22562