#1386 Hypertension is associated with deterioration of kidney function among patients with systemic lupus erythematosus, with or without lupus nephritis

Abstract

Abstract Background and Aims Systemic lupus erythematosus (SLE) frequently involves the kidneys, contributing to morbidity and mortality among this population. While hypertension often coexists with kidney involvement, it is not represented in the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index. Its effect on the morbidity and mortality of the SLE population in the Middle East should be evaluated. Our aims is to characterize the role of hypertension in Israeli SLE patients and identify variables associated with decreased eGFR over time. Method This retrospective study, conducted between 2014–2023 included adult patients with a diagnosis of SLE for at least 12 months. Kidney involvement was assessed based on a diagnosis of lupus nephritis (LN) on kidney biopsy. Hypertension was diagnosed based on documented diagnosis. Systolic and diastolic blood pressures were collected as continuous variables at multiple time-points. Associated variables, including socio-demographics, disease-related characteristics, kidney-related factors, comorbidities and all-cause mortality were assessed. Results A total of 182 patients were followed for a mean duration of 16.2 ± 13.8 years. Fifty-nine patients (32.4%) had chronic hypertension. Hypertension was more prevalent among SLE patients with LN [odds ratio (OR) 1.5, 95% CI 0.8-2.9, p = 0.23] as well as patients with chronic kidney disease (OR 7.2, 95% CI 1.9-27.7, p = 0.001). Patients with chronic hypertension had significantly relatively high rate of proteinuria at last follow-up (54.7%). On univariate analysis, patients with hypertension had higher rates of end-stage kidney disease (ESKD) (11.9% vs 1.6%, p = 0.003), heart failure (20.3% vs. 0.8%, p < 0.001), and all-cause mortality (16.9% vs. 0%, p < 0.001). All deaths (n = 10) occurred among hypertensive patients. LN and age were the most important predictors of hypertension on multivariate analysis (OR 6.2, 95% CI 2.4-16, p < 0.001; OR 1.1, 95% CI 1.1-1.2 p < 0.001, respectively). Repeated measures analysis showed that hypertension was significantly associated with decreased eGFR among SLE patients with or without LN (Fig. 1). Systolic and diastolic blood pressure were significantly correlated with age and inversely correlated with eGFR at last follow-up (Spearman's correlation coefficient 0.4, p < 0.01; 0.1, p = 0.07; −0.4, p < 0.01; −0.2, p = 0.04, respectively). Conclusion Hypertension is prevalent among Israeli patients with SLE, constituting a substantial comorbidity associated with ESKD, heart failure and mortality, irrespective of LN presence. Routine assessment and vigorous treatment of hypertension should be part of the management of patients with SLE.