SLE and Diabetes Associated With Higher Risk of Developing End-Stage Kidney Disease

Patients with both systemic lupus erythematosus (SLE) and diabetes vs those with SLE without diabetes have a 3-fold higher rate of developing end-stage kidney disease (ESKD), noted the authors of a paper published in Arthritis Care & Research. 

Researchers conducted a retrospective cohort study, using the Danish National Patient Register, to identify data from patients diagnosed with SLE between January 1996 and July 2018. The cohort included patients with diabetes, defined as date of first hospital contact for diabetes or date of first prescription for treatment for diabetes.

The study outcome was incident ESKD, which was defined as registration of dialysis, kidney transplant, or terminal renal insufficiency.

A total of 3178 patients with SLE (290 with diabetes and 2859 without diabetes) were included in the study.

The incidence rate of ESKD was higher among those with diabetes (7.8 per 1000 person-years) than those without (2.3 cases per 1000 person-years). After stratifying for age, sex, and education, the researchers found that risk for ESKD was 3 times higher among patients with SLE and diabetes than those with SLE without diabetes (hazard ratio [HR], 3.3; 95% CI, 1.8-6.1). 

In the multivariable-adjusted analysis, the researchers also observed that diabetes increased the rate of ESKD among both men and women, those aged at least 50 years, those with low educational levels, and those with hypertension at baseline. Of note, the highest incidence rate of ESKD was found in patients with SLE who had a concomitant history of diabetes and hypertension (HR, 0.6 [0.2-1.9]).

One of the study limitations included the inability to identify clinical descriptors of lupus nephritis while using the patient registry.

However, the study authors concluded “We found that [diabetes] is a significant risk factor for [ESKD] in SLE. Whether it is independent or related to specific phenotypes of SLE, other autoimmunity or treatment remains to be investigated. Our study also emphasizes the need for assessment and treatment of [diabetes] and hypertension in the care of patients with SLE.”