DISPARITIES IN OUTCOMES OF PATIENTS WITH LUPUS NEPHRITIS BASED ON AREA DEPRIVATION INDEX: A RETROSPECTIVE ANALYSIS

PV132 / #416 Poster Topic: AS15 - Lupus Nephritis-Clinical Background/Purpose Lupus nephritis (LN) is a significant complication of systemic lupus erythematosus, with varying histological classifications influencing treatment strategies and outcomes. Living in a disadvantaged neighborhood has been linked to several healthcare outcomes, including higher rates of diabetes and cardiovascular disease, increased utilization of health services, and earlier death. This study aims to compare clinical and laboratory outcomes at the time of biopsy and 12 months post-biopsy in patients with LN classified as class III, III/IV, IV, IV/V, and III/V based on area deprivation index (ADI). Methods A total of 95 patients were retrospectively identified who had undergone kidney biopsy from June 1st, 2016, until December 19th, 2023, at Houston Methodist Hospital. From these patients, those who did not have a follow-up visit or labs 12 months after biopsy were excluded. The remaining 62 were placed in 3 different categories by Area Deprivation Index (ADI), constructed from variables such as education, income, employment status, housing, and household characteristics to assess the level of neighborhood deprivation with higher numbers indicating more socioeconomic disparity. The categories were as follows; 1-39 (low), 40-69 (middle), 70-100 (high). The clinical characteristics were manually documented from the electronic medical record. Results Of the 62 patients, 25 (40.3%) patients were in the low, 24 (38.7%) in the middle, and 13 (21.0%) patients were in the high range. Demographic distribution and other characteristics are as described in Table 1. The serologies of the patients in each of the 3 ADI groups are presented in Table 2. Four (16.0%) patients in the high, 0 (100%) in the middle, and 2 (15.4%) met the laboratory criteria for antiphospholipid syndrome (positive lupus anticoagulant and/or moderate-high titer of anti-cardiolipin or anti-b2-glycoprotein antibody). The laboratory findings noted in each ADI group are discussed in Table 3 looking at values at the time of biopsy and 12 months after. Those in the higher ADI group, on average, had higher SLEDAI scores, higher creatinine, lower eGFR, and higher UPCR at the time of biopsy. These differences were noted at the 12-month mark after biopsy as well. Finally, it also appears that the middle ADI group has higher rates of obesity and smoking and perhaps, given this lifestyle, is experiencing worse outcomes, as their SLEDAI scores do not improve as much as others and eGFR and proteinuria worsen. They also are more likely to be on dialysis before and after biopsy. Table 1: Demographic, anthropometric, and social history of patients. Table 2: The number of patients in each ADI group with positive serologies. Table 3: The average laboratory findings comparing the 3 ADI groups at the time of biopsy and 12 months afterwards. (HD: hemodialysis, Cr: creatinine, Hgb: hemoglobin, WBC: white blood count, eGFR: estimated glomerular filtration rate) Conclusions This study highlights the crucial impact of socioeconomic factors, measured by the area deprivation index, on LN outcomes. Patients in disadvantaged areas face significant challenges, leading to worse initial presentations and results. Notably, middle ADI individuals may need more lifestyle modifications, which could improve their proteinuria, eGFR, SLEDAI scores, and decrease the likelihood of requiring hemodialysis. These findings underscore the urgent need for targeted interventions that address socioeconomic disparities and promote lifestyle changes in LN patients.

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