Half of Lupus Patients Develop Chronic Kidney Disease, Even Without Nephritis: Study Suggests
Israel: An 18-year follow-up of adults living with systemic lupus erythematosus (SLE) has revealed that more than half develop chronic kidney disease (CKD) over time, including a substantial proportion without a history of lupus nephritis (LN).
The findings, published in The Journal of Rheumatology, highlight the serious burden of CKD in SLE and its link to cardiovascular complications, higher hospitalization rates, and increased mortality.
The research, conducted by Dr. Keren Cohen-Hagai from the Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, and the Faculty of Medical and Health Sciences, Tel Aviv University, Israel, and colleagues, examined long-term outcomes in 175 adults diagnosed with SLE. Patients were followed for a mean of over 18 years, making this one of the more extensive assessments of kidney involvement in lupus.
The study revealed the following notable findings:
- During the study period, chronic kidney disease was diagnosed in 54.6% of patients, with nearly one in three demonstrating both reduced kidney function and albuminuria.
- Importantly, 46.1% of patients with CKD had no prior history of lupus nephritis, underscoring that renal complications in lupus are not limited to those with overt nephritis.
- Of the 175 patients included in the study, 12 eventually required kidney replacement therapy.
- Statistical analyses revealed that lupus nephritis was the strongest predictor of CKD, with a hazard ratio of 5.4.
- Other significant predictors of CKD included advancing age and lower estimated glomerular filtration rate (eGFR) at diagnosis.
- These findings suggest that while lupus nephritis is a powerful driver of kidney damage, clinicians should also remain vigilant in monitoring lupus patients without nephritis for potential signs of renal decline.
- The study further established that CKD in systemic lupus erythematosus carries broad systemic consequences, with patients who had CKD experiencing higher rates of cardiovascular morbidity.
- Patients with CKD were also more frequently hospitalized for lupus flare-ups and infections, highlighting the broader health burden associated with renal impairment in lupus.
- Mortality risk was markedly higher, with 19.1% of patients with CKD dying during follow-up compared to only 1.4% of those without CKD.
“Our findings highlight the critical need for early identification and close monitoring of kidney health in all lupus patients, not just those with lupus nephritis,” the authors noted. They emphasized that CKD in SLE should be considered a major determinant of long-term outcomes, requiring proactive management strategies to mitigate associated risks.
By revealing that nearly half of lupus patients with CKD had no nephritis history, the study challenges assumptions about renal involvement in SLE and broadens the scope of patients who may require closer nephrological evaluation. Given the rising recognition of CKD’s impact on quality of life and survival, the results stress the importance of timely diagnosis, routine kidney assessments, and targeted preventive measures in this high-risk population.
"The long-term investigation highlights CKD as a prevalent and clinically significant complication in lupus, with implications beyond renal health. Addressing kidney involvement early in the disease course may improve cardiovascular outcomes, reduce hospitalizations, and enhance survival in patients with SLE," the authors concluded.
Reference:
Prevalence, Risk Factors, and Outcomes of Chronic Kidney Disease in Patients With Systemic Lupus Erythematosus With and Without Lupus Nephritis. Keren Cohen-Hagai, Mor Saban, Sydney Benchetrit, Dorin Bar-Ziv, Naomi Nacasch, Moshe Shashar, Yael Pri-Paz Basson, Ori Wand, Ayelet Grupper, Shaye Kivity, Oshrat E. Tayer-Shifman. The Journal of Rheumatology Jul 2025, jrheum.2024-1087; DOI: 10.3899/jrheum.2024-1087
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