Improvement of outcomes in patients with lupus nephritis: management evolution in Chinese patients from 1994 to 2010

To assess how the long-term outcomes has changed over the past decades in Chinese patients with lupus nephritis (LN). The trends in patient manifestation at presentation, treatment pattern and therapeutic effects were evaluated.

A cohort of biopsy-proven LN patients (n=1945) from January 1994 to December 2010 was analyzed. Treatment regimens, treatment response, renal relapse, and renal outcome were compared at different time periods (1994-1998, 1999-2004, and 2005-2010).

Patients in the later periods had shorter duration of disease, lower serum creatinine value and chronicity at biopsy, and more frequent follow-up. They were more likely to receive standard of care therapies, which included cyclophosphamide, mycophenolate mofetil and combined therapy. Patients in the later periods had higher probabilities of achieving remission (P < 0.001) and lower probabilities of experiencing renal flare (P = 0.007). The 5-year renal survival rates were 92.6%, 90.6% and 94.3% in 1994-1998, 1999-2004 and 2005-2010, respectively. The 5-year risk of end-stage renal disease (ESRD) did not differ between 1994-1998 and 1999-2004, but was significantly lower in 2005-2010 (hazard ratio 0.40 [95% confidence interval, 0.19-0.85] versus 1999-2004). In multivariable COX analysis, standard therapy was independently associated with lower risk of ESRD (adjusted OR 0.70, 95% CI 0.51-0.97, P=0.034). Parameters of renal damage at biopsy (renal function, AI and CI) were independently associated with poor outcome.

The outcomes of Chinese patients with LN have improved from 1994 to 2010. With the increased use of standard therapies, the remission rates have increased and renal relapse has decreased.