Spondyloarthritis Patients Suffer Increased Risk of Renal Complications Compared With General Population: A Retrospective Observational Study.

Min Xiao,Zetao Liao,Yutong Jiang,Zhiming Lin,Shuangyan Cao,Jieruo Gu,Xiaomin Li,Mingcan Yang,Qing Lv,Liudan Tu,Qiujing Wei,Xuqi Zheng,Yanli Zhang

doi:10.3389/fphar.2019.01073

Abstract

The objective of this study was to identify the prevalence and risk factors of renal complications of spondyloarthritis (SpA) patients, and to assess increased risks compared to general people. We conducted a retrospective study enrolled with consecutive SpA patients from an inpatient department and age, sex-matched general population (GP). The renal disorders investigated in this study contained decreased estimated glomerular filtration rate (eGFR), hematuria, proteinuria and nephrolithiasis. A total of 350 admitted SpA patients with complete medical records and 323 age and sex-matched GP were enrolled. Most SpA patients were male (n = 283, 80.9%) and the mean age was 31.61 ± 10.73 years old. Among 350 SpA patients, 29 (8.8%) suffered from hematuria, six (1.8%) suffered from proteinuria, one (0.3%) had decreased eGFR, and 27 (13.0%) presented with nephrolithiasis. The relative risk (RR) of nephrolithiasis in SpA compared to the GP was 2.24 (95% CI, 1.00-4.98), and the RR of renal insufficiency was 2.04 (95% CI, 1.11-3.77). In a univariate analysis, nephrolithiasis was significantly associated with age, age of onset, smoking, extra-articular manifestation and a bamboo spine. Renal insufficiency was significantly associated with age, peripheral manifestation, serum albumin, C-reactive protein and erythrocyte sedimentation rate. In a multivariable analysis, only extra-articular manifestation (OR = 8.43, 95% CI, 1.65-43.06, p = 0.010) and bamboo spine (OR = 3.47, 95% CI, 1.01-12.06, p = 0.049) remained significantly associated with nephrolithiasis. However, no variable was recognized as an independent risk factor for renal insufficiency. Renal complications are more common in SpA patients, with more than two-fold increased risk compared with GP. Extra-articular manifestation and bamboo spine are independent risk factors of renal disease in SpA patients.

Highlights

Spondyloarthritis (SpA) is a chronic inflammatory disease characterized by spinal and sacroiliac joint involvement, of which ankylosing spondylitis (AS) is the main subtype (Sieper et al, 2009)
chronic kidney disease (CKD) was studied in this research study, there is no study comparing the risks of renal impairment between SpA patients and the general population (GP) in China
All of the 350 included patients had serum creatinine data for estimated glomerular filtration rate (eGFR) calculation, 328 patients had carried out urinalysis, 207 of which had never carried out renal ultrasonic examination before

Summary

Introduction

Spondyloarthritis (SpA) is a chronic inflammatory disease characterized by spinal and sacroiliac joint involvement, of which ankylosing spondylitis (AS) is the main subtype (Sieper et al, 2009). As a chronic systemic inflammatory disease (Dulger et al, 2018), it has been reported that the risk of other organs being involved in SpA such as in osteoporosis (Wang et al, 2015), cardiovascular disease (Mathieu et al, 2015), gastrointestinal diseases (Molto et al, 2016) and renal diseases (Couderc et al, 2018), has increased. There were several studies reporting the prevalence of renal complications with SpA (Kristensen et al, 2015; Barbouch et al, 2018; Couderc et al, 2018). CKD was studied in this research study, there is no study comparing the risks of renal impairment between SpA patients and the GP in China

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