Lupus Nephritis, End-Stage Kidney Disease Tied to Heart Disease and Events

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Patients with lupus nephritis are at a “considerable” risk of heart disease and cardiovascular events compared to the general population, according to recently published data.

A team of investigators recently presented findings showing that, in particular, patients with lupus nephritis plus end-stage kidney disease (ESKD) were at higher risk of events including myocardial infarction (MI)—or heart attacks—stroke, and transient ischemic attacks. The data also showed disparities in heart disease burdens among patients with lupus: patients in North America report a higher prevalence of events and diagnosed disease than their peers in Asia.

The investigators conducted a systematic review and meta-analysis to analyze the prevalence of cardiovascular events and related deaths in patients with lupus nephritis. Borne from systemic lupus erythematosus (SLE), lupus nephritis is highly prevalent among women of reproductive age and can associate frequently with premature cardiovascular morbidity, the team noted.

“Patients with SLE are susceptible to various cardiovascular diseases, and previous studies have indicated that LN is associated with a 2.8 to 8.5 times increased risk of cardiovascular events (CVE) among sufferers,” investigators wrote. “Despite a 44 percent reduction in cardiovascular deaths from the 1995–1999 to 2010–2014 timeframes, the exact pathophysiological mechanisms for CVE development in LN patients remain unknown. Moreover, the true prevalence of CVE in these patients has yet to be elucidated, highlighting the need for comprehensive study.”

Cardiovascular events were defined as reported MI, heart failure (HF), ischemic heart disease, angina pectoris, and cerebrovascular disease including stroke and transient ischemic attack.

The team additionally sought to define the occurrence rate of cardiovascular events in patients stratified by the presence of comorbid ESKD, as well as for the specific prevalence of event types. Their literature review concluded in July 2023.

Investigators identified 18 relevant articles for analysis from an initial screening of 1138 studies. They observed an overall pooled occurrence of cardiovascular events in eight percent of patients with lupus nephritis.

Among nine studies with 30,856 participants that which reported MI as an outcome variable in patients with lupus nephritis, the pooled occurrence of the cardiovascular event was four percent. In another 10 studies with 40,235 participants that included cerebrovascular events, the pooled occurrence of stroke or transient ischemic attack was five percent.

Vakhshoori and colleagues additionally observed a nearly five-fold increased prevalence of cardiovascular events among patients with lupus nephritis in North America versus those in Asia; in Europe, the occurrence was approximately four-fold greater.

Lastly, via six articles including 64,958 participants, investigators observed that eight percent of patients with ESKD due to lupus nephritis had a cardiovascular event.

“This study underscores the persistent significant occurrence of CVE in individuals with lupus nephritis, despite a decreasing trend in cardiovascular disease rates,” investigators concluded. “These findings emphasize the importance of implementing optimized healthcare management plans to perform appropriate preventive and therapeutic strategies which can effectively result reduction in the burden of lupus nephritis-related CVE and improve outcomes for the affected individuals.”

An original version of this article was published on sister site HCPLive.