Long-term renal outcomes, cardiovascular events and severe infections in patients with lupus nephritis: MassiLUP cohort 2001-2022.

Abstract

Few recent epidemiological data are available on the risks of chronic kidney disease (CKD), cardiovascular events and infections, in patients with LN, even though these data are crucial for guiding therapeutic decisions. We conducted a cohort study with the aim of evaluating survival without CKD and adverse events in patients with LN. All patients with a first flare of biopsy-proven LN between 2001 and 2022 followed-up in the University Hospital of Marseille, France, were included in MassiLUP. Patient survival, survival without CKD stages 3, 4 and 5, without cardiovascular event, without severe infection (hospitalization or zoster) and without cancer were assessed. One hundred and sixty-eight patients (82.7% female) were included, mean follow-up was 9.6 ± 5.7 years. Most patients had class III or IV (+/-V) LN. Four patients died (three severe infections and one stroke); 41 (24.4%) patients developed CKD, among whom 19 (11.3%) reached ESKD; 34 (20.2%) patients presented a cardiovascular event, 59 (35.1%) a severe infection and 12 (7.1%) a cancer. Survival rates without CKD were 82.9% and 74.6% at 5 and 10 years; without cardiovascular event were 85.7% and 77.3% at 5 and 10 years; without severe infection were 76.3% and 63.8% at 5 and 10 years; without cancer were 96.3% and 92.9% at 5 and 10 years. Despite free access to treatment and care in France, the long-term prognosis of patients with LN remains burdened both by the risk of CKD, and the risks of cardiovascular and infectious events.