RT Journal Article
SR Electronic
T1 Disease activity of rheumatoid arthritis and kidney function decline: a large prospective registry study
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP ard-2024-226156
DO 10.1136/ard-2024-226156
A1 Fukui, Sho
A1 Winkelmayer, Wolfgang C
A1 Tedeschi, Sara K
A1 Marrugo, Javier
A1 Guan, Hongshu
A1 Harrold, Leslie
A1 Litman, Heather J
A1 Shinozaki, Tomohiro
A1 Solomon, Daniel H
YR 2024
UL http://ard.bmj.com/content/early/2024/08/21/ard-2024-226156.abstract
AB Introduction Chronic kidney disease (CKD) is a common comorbidity of rheumatoid arthritis (RA). The association of longitudinal RA disease activity with long-term kidney function has remained uncertain.Method We analysed a multicentre prospective RA registry in the USA from 2001 to 2022. The exposure was updated time-averaged Clinical Disease Activity Index (TA-CDAI) categories from study enrolment. The primary outcome was a longitudinal estimated glomerular filtration rate (eGFR) change. Secondary outcomes included developments of CKD stage G3a (eGFR<60 mL/min/1.73 m2) and stage G3b (eGFR<45 mL/min/1.73 m2). Results were adjusted for relevant time-fixed and time-varying covariates.Results 31 129 patients (median age: 58.0 years, female: 76.3%, median eGFR: 90.7 mL/min/1.73 m2) contributed 234 973 visits and 146 778 person-years of follow-up. Multivariable mixed-effect linear model showed an average annual eGFR decline during follow-up in the TA-CDAI-remission group of −0.83 mL/min/1.73 m2 and estimated additional annual declines (95% CI) of –0.09 (–0.15 to –0.03) in low, –0.17 (−0.23 to –0.10) in moderate and −0.18 (–0.27 to –0.08) mL/min/1.73 m2 in high disease activity patients. Compared with TA-CDAI remission, adjusted HRs (95% CI) for CKD stage G3a during follow-up were 1.15 (1.01 to 1.30) in low, 1.22 (1.06 to 1.40) in moderate and 1.27 (1.05 to 1.52) in high disease activity; for CKD stage G3b, 1.22 (0.84 to 1.76) in low, 1.66 (1.12 to 2.45) in moderate and 1.93 (1.16 to 3.20) in high disease activity.Conclusions Higher RA disease activity was associated with accelerated eGFR decline and increased risk of clinically relevant kidney dysfunction. Future intervention studies should attempt to replicate the association between RA disease activity and eGFR.No data are available. Data are not available publicly.