TY - JOUR
T1 - Development of reduced kidney function in rheumatoid arthritis
AU - Hickson, Latonya J.
AU - Crowson, Cynthia S.
AU - Gabriel, Sherine E.
AU - McCarthy, James T.
AU - Matteson, Eric L.
N1 - Funding Information:
Support: This work was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (NIH) (grant R01AR46849 ) and by the National Institute on Aging of the NIH (grant R01AG034676 ). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
PY - 2014/2
Y1 - 2014/2
N2 - Background Rheumatoid arthritis (RA) is associated with a variety of kidney disorders. However, it is unclear whether the development of reduced kidney function is higher in patients with RA compared to the general population. Study Design Retrospective review. Setting & Participants Incident adult-onset RA cases (813) and a comparison cohort of non-RA individuals (813) in Olmsted County, MN, in 1980-2007. Predictor Baseline demographic and clinical variables. Outcomes Reduced kidney function: (1) estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 and (2) eGFR < 45 mL/min/1.73 m 2 on 2 consecutive occasions at least 90 days apart; cardiovascular disease (CVD); and death. Measurements The cumulative incidence of reduced kidney function was estimated adjusting for the competing risk of death. Results Of 813 patients with RA and 813 non-RA individuals, mean age was 56 ± 16 (SD) years, 68% were women, and 9% had reduced kidney function at baseline. The 20-year cumulative incidence of reduced kidney function was higher in patients with RA compared with non-RA participants for eGFR < 60 mL/min/1.73 m 2 (25% vs 20%; P = 0.03), but not eGFR < 45 mL/min/1.73 m 2 (9% vs 10%; P = 0.8). The presence of CVD at baseline (HR, 1.77; 95% CI, 1.14-2.73; P = 0.01) and elevated erythrocyte sedimentation rate in patients with RA (HR per 10-mm/h increase, 1.08; 95% CI, 1.00-1.16; P = 0.04) was associated with increased risk of eGFR < 60 mL/min/1.73 m2. eGFR < 60 mL/min/1.73 m2 was not associated with increased risk of CVD development in patients with RA (HR, 0.99; 95% CI, 0.63-1.57; P = 0.9), however, a greater reduction in GFR (eGFR < 45 mL/min/1.73 m2) was associated with increased risk of CVD (HR, 1.93; CI, 1.04-3.58; P = 0.04). Limitations Reduced kidney function was defined by estimating equations for kidney function. We are limited to deriving associations from our findings. Conclusions Patients with RA were more likely to develop reduced kidney function over time. CVD and associated factors appear to play a role. The presence of RA in individuals with reduced kidney function may lead to an increase in morbidity from CVD development, for which awareness may provide a means for optimizing care.
AB - Background Rheumatoid arthritis (RA) is associated with a variety of kidney disorders. However, it is unclear whether the development of reduced kidney function is higher in patients with RA compared to the general population. Study Design Retrospective review. Setting & Participants Incident adult-onset RA cases (813) and a comparison cohort of non-RA individuals (813) in Olmsted County, MN, in 1980-2007. Predictor Baseline demographic and clinical variables. Outcomes Reduced kidney function: (1) estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 and (2) eGFR < 45 mL/min/1.73 m 2 on 2 consecutive occasions at least 90 days apart; cardiovascular disease (CVD); and death. Measurements The cumulative incidence of reduced kidney function was estimated adjusting for the competing risk of death. Results Of 813 patients with RA and 813 non-RA individuals, mean age was 56 ± 16 (SD) years, 68% were women, and 9% had reduced kidney function at baseline. The 20-year cumulative incidence of reduced kidney function was higher in patients with RA compared with non-RA participants for eGFR < 60 mL/min/1.73 m 2 (25% vs 20%; P = 0.03), but not eGFR < 45 mL/min/1.73 m 2 (9% vs 10%; P = 0.8). The presence of CVD at baseline (HR, 1.77; 95% CI, 1.14-2.73; P = 0.01) and elevated erythrocyte sedimentation rate in patients with RA (HR per 10-mm/h increase, 1.08; 95% CI, 1.00-1.16; P = 0.04) was associated with increased risk of eGFR < 60 mL/min/1.73 m2. eGFR < 60 mL/min/1.73 m2 was not associated with increased risk of CVD development in patients with RA (HR, 0.99; 95% CI, 0.63-1.57; P = 0.9), however, a greater reduction in GFR (eGFR < 45 mL/min/1.73 m2) was associated with increased risk of CVD (HR, 1.93; CI, 1.04-3.58; P = 0.04). Limitations Reduced kidney function was defined by estimating equations for kidney function. We are limited to deriving associations from our findings. Conclusions Patients with RA were more likely to develop reduced kidney function over time. CVD and associated factors appear to play a role. The presence of RA in individuals with reduced kidney function may lead to an increase in morbidity from CVD development, for which awareness may provide a means for optimizing care.
KW - Cardiovascular disease
KW - estimated glomerular filtration rate (eGFR)
KW - glomerulonephritis
KW - kidney dysfunction
KW - mortality
KW - renal progression
KW - rheumatoid arthritis (RA)
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U2 - 10.1053/j.ajkd.2013.08.010
DO - 10.1053/j.ajkd.2013.08.010
M3 - Article
C2 - 24100126
AN - SCOPUS:84892908134
SN - 0272-6386
VL - 63
SP - 206
EP - 213
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -