Causes of death in patients with severe lupus nephritis

Abstract

INTRODUCTION: Improvements in immunosuppression and medical care have brought about changes in the clinical outcome of patients with lupus nephritis. We investigated the causes and the mortality risk factors of these patients in the present era. METHODS: This was a retrospective study of all patients followed in a lupus nephritis clinic since January 1971. The causes of death were identifi ed and the standardized mortality ratios (SMR) of potential risk factors were calculated with reference to the local general population. RESULTS: 287 Chinese patients were included. The follow-up was 5164.1 personyears (mean 18.0 ± 8.4 years). 230 patients (80.1%) had a history of Class III/IV ± V renal involvement. 27 patients (9.4%) died during follow-up. The 5-, 10-, and 20-year patient survival rates were 98.9%, 98.1% and 90.9% respectively, while corresponding renal survival rates were 98.6%, 96.6% and 85.3% respectively. The leading causes of death were infection (44.8%), malignancy (20.7%) and cardiovascular disease (17.2%). The overall SMR was 6.3, while that associated with renal involvement, endstage renal failure, malignancy, and cardiovascular disease was 6.4, 26.1, 13.0, and 11.4 respectively. CONCLUSION: Lupus nephritis is associated with a 6.4-fold increase in the risk of death compared with the general population, and lupus patients who develop endstage renal failure have a 26-fold excess in the risk of death.