Survival analysis and causes of mortality in patients with lupus nephritis Nephrology Dialysis Transplantation, 05/25/2012

Yap DYH et al. – Lupus nephritis is associated with a 6–fold increase in mortality compared with the general population. Lupus patients who develop end–stage renal disease have a 26–fold excess in the risk of death, which is more than twice the risk associated with malignancy or cardiovascular disease in these patients.

• The records of all lupus nephritis patients followed in a single centre during 1968–2008 were reviewed.
• The causes of death were identified, the survival curves constructed and the standardized mortality ratios (SMRs) of potential risk factors were calculated with reference to the local general population.

• Two hundred and thirty systemic lupus erythematosus patients with history of renal involvement (predominantly Class III/IV lupus nephritis with or without membranous features) were included.
• The follow–up was 4076.6 person–years (mean 17.7 ± 8.9 years).
• Twenty–four patients (10.4%) died, and 85% of the deaths occurred after 10 years of follow–up.
• The 5–, 10–, and 20–year survival rates were 98.6, 98.2 and 90.5%, respectively.
• The leading causes of death were infection (50.0%), cardiovascular disease (20.8%) and malignancy (12.5%).
• The renal survival rates at 5, 10 and 20 years were 99.5, 98.0 and 89.7%, respectively.
• The SMR in patients with renal involvement, end–stage renal disease (ESRD), malignancy or cardiovascular disease was 5.9, 26.1, 12.9 and 13.6, respectively.