Hydroxychloroquine Use Linked to Slower Kidney Function Decline in Lupus Nephritis Patients: Study Finds
USA: A study published in Arthritis Care & Research has highlighted the significant protective effect of hydroxychloroquine (HCQ) on kidney function among patients with lupus nephritis (LN). Conducted by Dr. Shivani Garg and colleagues from the University of Wisconsin School of Medicine & Public Health, the research emphasizes both the early and long-term benefits of HCQ in slowing the progression of renal impairment in this high-risk group.
Lupus nephritis, a severe manifestation of systemic lupus erythematosus, is a major cause of kidney failure and long-term morbidity. Although HCQ is widely used to prevent disease flares, its direct impact on preserving kidney function has been debated, with previous cohort studies reporting mixed findings. This study aimed to clarify those inconsistencies by evaluating the time-dependent effects of HCQ on renal outcomes using a well-defined biopsy-proven LN cohort.
The researchers retrospectively analyzed data from 209 patients with biopsy-confirmed lupus nephritis. Serum creatinine levels from diagnosis through the last follow-up were used to estimate glomerular filtration rate (eGFR). HCQ exposure was treated as a time-varying factor to assess its association with sustained declines in kidney function, defined as reductions in eGFR of 30% or 40% from baseline. Additionally, annual changes in eGFR slopes were calculated using linear mixed-effects models.
The findings were compelling and are summarized as follows:
- 33% of patients experienced a ≥30% decline in eGFR, while 23% showed a ≥40% decline during the follow-up period.
- Patients treated with HCQ demonstrated significantly better kidney outcomes compared to those not on the medication.
- HCQ use was linked to a 60% lower risk of experiencing a ≥30% eGFR decline.
- The risk of a ≥40% eGFR decline was reduced by 62% in patients receiving HCQ after adjusting for propensity scores.
- Among patients with chronic kidney disease stage 3 or higher, HCQ use was associated with a 77% decreased risk of further kidney function deterioration.
- HCQ reduced the annual eGFR decline rate by 5.12 mL/min/1.73 m² within the first five years of diagnosis.
- Over ten years, the annual decline in eGFR was lowered by 3.17 mL/min/1.73 m², indicating HCQ’s sustained renal protective effect.
According to the authors, these findings strongly support universal HCQ use in patients with lupus nephritis, regardless of baseline kidney function. “Our data suggest that hydroxychloroquine is not just effective in preventing flares but plays a critical role in preserving renal function early and over the long term,” they concluded.
By demonstrating that HCQ use significantly mitigates kidney function decline, this study adds to the growing body of evidence supporting its role as a cornerstone therapy in lupus nephritis management. Early initiation and sustained use of HCQ may offer a vital strategy to delay or prevent progression to end-stage kidney disease in these patients.
Reference:
Garg, S., Rovin, B., Astor, B. C., Singh, T., Hollnagel, F., Kuik, M., Kolton, L., Saric, C., Lim, S. S., & Bartels, C. M. Hydroxychloroquine Associated with Lower Glomerular Filtration Rate Decline in Lupus Nephritis. Arthritis Care & Research. https://doi.org/10.1002/acr.25616
