In SLE, Renal Damage Is No. 1 Death Predictor

Preventing renal damage in patients with systemic lupus erythematosus (SLE) may be critical to lowering their mortality rate, according to a new report.

Researchers at the University of Alabama in Birmingham found that the renal domain of the Systemic Lupus International Collaborating Clinics (SLICC) damage index is the most important predictor of death after adjusting for poverty -- a strong predictor of mortality.

Damage accrual in SLE patients is an independent predictor of mortality, but which of the 12 domains of the SLICC damage index is the most important has been unknown. The investigators studied 635 SLE patients aged 16 years or older. Of these, 570 (89%) were women who had a mean age of 36.5 years. All subjects had disease duration of five years or less at enrollment. Disease activity was assessed by the investigators using the Systemic Lupus Activity Measure-Revised (SLAM-R) at diagnosis and damage at the last visit.

Of the 635 patients, renal damaged developed in 126, cardiovascular damage developed in 63, pulmonary damage developed in 48, and peripheral vascular damage developed in 34. A total of 97 patients died. After adjusting for poverty, the investigators found that renal damage was the most important predictor of death within the damage index.

“We found that the renal domain was even more important that the cardiovascular domain,” said study co-investigator Graciela Alarcón, MD, MPH, a professor of medicine, and a member of the Lupus Foundation of America's Medical-Scientific Advisory Council.

The findings, presented here at the American College of Rheumatology annual meeting, should be of particular interest to nephrologists because they highlight the importance of preventing renal damage with agents such as hydroxychloroquine, which originally was used to prevent and treat malaria, Dr. Alarcón said.

“Nephrologists need to realize that although hydroxychloroquine was dismissed in the past, it could actually protect the patient from renal damage, which we have now found is a harbinger of worse things to come,” she said.

Source: January 2009 Issue of Renal And Urology News