Development of reduced kidney function in rheumatoid arthritis

LaTonya Hickson, Cynthia Crowson, Sherine E. Gabriel, James T. McCarthy, Eric Lawrence Matteson

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)206-213
Number of pages8
JournalAmerican Journal of Kidney Diseases
Volume63
Issue number2
DOIs
StatePublished - Feb 2014

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Rheumatoid Arthritis
Glomerular Filtration Rate
Kidney
Cardiovascular Diseases
Arthritis
Blood Sedimentation
Incidence
Retrospective Studies
Demography
Morbidity
Population

Keywords

  • Cardiovascular disease
  • estimated glomerular filtration rate (eGFR)
  • glomerulonephritis
  • kidney dysfunction
  • mortality
  • renal progression
  • rheumatoid arthritis (RA)

ASJC Scopus subject areas

  • Nephrology

Cite this

Development of reduced kidney function in rheumatoid arthritis. / Hickson, LaTonya; Crowson, Cynthia; Gabriel, Sherine E.; McCarthy, James T.; Matteson, Eric Lawrence.

In: American Journal of Kidney Diseases, Vol. 63, No. 2, 02.2014, p. 206-213.

Research output: Contribution to journalArticle

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abstract = "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.",
keywords = "Cardiovascular disease, estimated glomerular filtration rate (eGFR), glomerulonephritis, kidney dysfunction, mortality, renal progression, rheumatoid arthritis (RA)",
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AU - Hickson, LaTonya

AU - Crowson, Cynthia

AU - Gabriel, Sherine E.

AU - McCarthy, James T.

AU - Matteson, Eric Lawrence

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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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