INFLUENCE OF AGE OF ONSET OF LUPUS NEPHRITIS ON OUTCOMES: AN INCEPTION COHORT-BASED STUDY

PV124 / #678 Poster Topic: AS15 - Lupus Nephritis-Clinical Background/Purpose Renal involvement in systemic lupus erythematosus (SLE) most commonly occurs in women of the reproductive age group. However, it may theoretically start at any age. In this study, we aimed to explore the impact of early vs late-onset lupus nephritis (EoLN vs LoLN) on clinical presentation and disease outcomes. Methods We included 246 inception cohort patients who developed LN during follow-up. We classified patients based on the age of onset of LN into EoLN (before age 50; 205 patients) and LoLN (50 years or older; 41 patients). Outcomes included complete proteinuria recovery (CPR) at 1 year, an adverse composite outcome (end-stage kidney disease [ESKD], a sustained ≥40% decline in eGFR, or death), subsequent LN flares (doubling of proteinuria to ≥1 g/day after complete response or to ≥2 g/day partial response), and a ≥1 point increase in non-renal SLICC damage index (SDI). The association with outcomes was studied using Cox proportional hazards model. Results At baseline, the median [IQR] age was 31.4 [25.2, 38.5] years for EoLN and 58.4 [53.9, 63.5] years for LoLN. LoLN patients exhibited higher median creatinine levels, lower median eGFR, reduced proteinuria, and a lower median SLEDAI-2K score compared to EoLN patients. On long-term follow-up (median 8.5 years [IQR 4.2, 15.5]), the rates of achieving CRR, adverse composite outcomes, and renal flares were comparable between the 2 groups (Table 1). However, the LoLN group demonstrated a significantly higher incidence of a ≥1 point increase in non-renal SDI. Additionally, the time to damage accrual was notably shorter in the LoLN group (Figure 1). Cox proportional hazard models confirmed these results by showing no significant differences between the 2 groups in terms of achieving CRR (LoLN vs. EoLN, HR 1.29, 95% CI 0.76-2.18, p=0.35), developing adverse composite outcomes (LoLN vs. EoLN, HR 1.16, 95% CI 0.57-2.35, p=0.68), or experiencing renal flares (HR 0.54, 95% CI 0.23-1.28, p=0.16). Notably, LoLN was associated with significantly higher odds of a ≥1 point increase in non-renal SDI (HR 2.37, 95% CI 1.42-3.97, p<0.01). Table 1. Rate and time to short and long-term outcomes of patients with early- and late-onset lupus nephritis. Figure 1. Kaplan-Meier curve showing the differences between the early- and late-onset lupus nephritis groups in time to a ≥1 point increase in non-renal SDI. Conclusions Late-onset lupus nephritis (LN) is not associated with significant differences in short- or long-term renal outcomes; however, it is associated with increased damage accrual over time.

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