Cardiometabolic risk, evaluation and control in lupus nephritis

Résumé fourni par la source

Aim: Lupus nephritis (LN) is associated with atherosclerotic cardiovascular disease but early recognition of cardiometabolic risk in patients with LN can facilitate risk optimization with disease-modifying strategies. To identify potential gaps in cardiometabolic risk management in LN in real-world practice, we aimed to evaluate the prevalence and trend in cardiometabolic risk, evaluation and control. Methods: We performed a single-center, cross-sectional study of all adults with biopsy-confirmed LN between 2011 and 2022 to (1) assess the prevalence of cardiometabolic risks (age, sex, diabetes mellitus, hypertension, hyperlipidemia, ischemic heart disease [IHD], reduced kidney function [estimated glomerular filtration rate, eGFR <60 ml/min/1.73 m2], urine protein-to-creatinine ratio [UPCR] >0.15 g/g, glucocorticoid use), evaluation (office blood pressure [BP], fasting glucose and lipid and HbA1c) and control at the time of diagnosis; and then (2) evaluate the association between time periods (2019-2022 compared to 2015-2018) and cardiometabolic evaluation and control, adjusting for traditional and SLE disease-specific cardiometabolic risks in multivariable logistic regression models. Results: We evaluated 326 adults with LN [median age 42.0 years (interquartile range: 30.9, 52.7)]. Across the three time periods, reduced kidney function was most frequent in 2011-2014. Hypertension and renin-angiotensin system (RAS) blocker use were lowest in 2019-2022 (23.4% and 30.9% respectively), while 38.0% achieved BP<130/80 mmHg without significant change across time periods. Glycemic evaluation was lowest in 2019-2022 (78.7%) compared to earlier time periods. Achievement of glycemic targets of fasting glucose <6.1 mmol/L and HbA1c ≤ 7% were 70.0% and 95.1% respectively, without significant change across the time periods. Lipid evaluation was performed in 75.8% but only 32.0% achieved LDL-cholesterol <2.6 mmol/L. There was no significant change in the prevalence of lipid evaluation or control over time. Conclusion Glycemic assessment and optimization of blood pressure and lipid treatment to achieve guideline-recommended targets represent opportunities to improve cardiometabolic risk management in LN.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.