Renal dysfunction among rheumatoid arthritis patients: A retrospective cohort study

Ashraf O Oweis, Khaldoon M Alawneh, Sameeha A Alshelleh, Fatima Alnaimat, Diala Alawneh, Deeb Jamil Zahran, Ashraf O Oweis, Khaldoon M Alawneh, Sameeha A Alshelleh, Fatima Alnaimat, Diala Alawneh, Deeb Jamil Zahran

Abstract

Background: Rheumatoid arthritis (RA) is a common rheumatological disease which can involve a variety of different renal manifestations. This may be explained by disease effect itself or by medications used for treatment that may lead to renal dysfunction and its complications.We aimed to identify the prevalence and factors that played a role in renal dysfunction among RA Jordanian patients.

Method: 285 patients with RA visiting outpatient clinic between March 2016 and March 2017 were included in a retrospective study design. Age, gender, comorbidities, duration of the disease, medications and laboratory results were gathered and scoring of RA activity was done.

Results: Data gathered from the 285 patients showed a female predominance with 88.4% female and 11.6% male. The average disease duration was 6.7 years. Age, DM, HTN, and serum CRP were associated with worse renal function on univariate analysis. 44 patients (18.8%) presented with microscopic hematuria, 16 (6.9%) with proteinuria and only 5 (2.1%) patients presented with both microscopic hematuria and proteinuria. Patients with eGFR <60 ml/min had longer disease duration with a mean of 11 years (±7.7) in comparison to 6.4 years (±6.1) for those with eGFR>90 ml/min (P = 0.001).

Conclusion: Renal dysfunction is not common in RA Jordanian population and has variable presentations. Age and the duration of illness play a major role in the progression of CKD if present. Future prospective studies evaluating renal biopsies in RA patients are needed.

Keywords: Drugs; Hematuria; Proteinuria; Renal involvement; Rheumatoid arthritis.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2020 The Authors.

References

    1. Alawneh K.M., Khassawneh B.Y., Ayesh M.H., Smadi M. Rheumatoid arthritis in Jordan: a cross sectional study of disease severity and associated comorbidities. Therapeut. Clin. Risk Manag. 2014;10:363–366. doi: 10.2147/tcrm.S62954.
    1. Widemann B.C., Adamson P.C. Understanding and managing methotrexate nephrotoxicity. Oncol. 2006;11:694–703. doi: 10.1634/theoncologist.11-6-694.
    1. Durando M., Tiu H., Kim J.S. Sulfasalazine-induced crystalluria causing severe acute kidney injury. Am. J. Kidney Dis. 2017;70:869–873. doi: 10.1053/j.ajkd.2017.05.013.
    1. Braun A., Zeier M. Rheumatoid arthritis and the kidney: uneasy companions. Nephron Clin. Pract. 2004;96:c105–c106. doi: 10.1159/000077371.
    1. Liu Y., Wen H.Y., Wang L.H., Wang C. Focal segmental glomerulosclerosis lagged behind the onset of rheumatoid arthritis by 7 years: a case report and literature review. Medicine (Baltim.) 2017;96:e5789. doi: 10.1097/md.0000000000005789.
    1. Muthukumar P., Dhanapriya J., Gopalakrishnan N., Dineshkumar T., Sakthirajan R., Balasubramaniyan T. Evaluation of renal lesions and clinicopathologic correlation in rheumatoid arthritis. Saudi J. Kidney Dis. Transpl. 2017;28:44–50. doi: 10.4103/1319-2442.198118.
    1. Pathan E., Joshi V.R. Rheumatoid arthritis and the kidney. J. Assoc. Phys. India. 2004;52:488–494.
    1. Agha R., Abdall-Razak A., Crossley E., Dowlut N., Iosifidis C., Mathew G., for the STROCSS Group The STROCSS 2019 guideline: strengthening the reporting of cohort studies in surgery. Int. J. Surg. 2019;72:156–165.
    1. Arnett F.C., Edworthy S.M., Bloch D.A., McShane D.J., Fries J.F., Cooper N.S. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31:315–324.
    1. Kasturi S., Goldstein B.L., Malspeis S., Karlson E.W., Costenbader K.H. Comparison of the 1987 American College of Rheumatology and the 2010 American College of Rheumatology/European League against rheumatism criteria for classification of rheumatoid arthritis in the nurses' health study cohorts. Rheumatol. Int. 2014;34:407–411. doi: 10.1007/s00296-013-2865-2.
    1. Berglin E., Dahlqvist S.R. Comparison of the 1987 ACR and 2010 ACR/EULAR classification criteria for rheumatoid arthritis in clinical practice: a prospective cohort study. Scand. J. Rheumatol. 2013;42:362–368. doi: 10.3109/03009742.2013.776103.
    1. Aletaha D., Smolen J. The simplified disease activity index (SDAI) and the clinical disease activity index (CDAI): a review of their usefulness and validity in rheumatoid arthritis. Clin. Exp. Rheumatol. 2005;23:S100–S108.
    1. White C.A., Allen C.M., Akbari A., Collier C.P., Holland D.C., Day A.G. Comparison of the new and traditional CKD-EPI GFR estimation equations with urinary inulin clearance: a study of equation performance. Clin. Chim. Acta. 2019;488:189–195. doi: 10.1016/j.cca.2018.11.019.
    1. Mori S., Yoshitama T., Hirakata N., Ueki Y. Prevalence of and factors associated with renal dysfunction in rheumatoid arthritis patients: a cross-sectional study in community hospitals. Clin. Rheumatol. 2017;36:2673–2682. doi: 10.1007/s10067-017-3804-5.
    1. Gijon-Conde T., Sanchez-Martinez M., Graciani A., Cruz J.J., Lopez-Garcia E., Ortola R. Impact of the European and American guidelines on hypertension prevalence, treatment, and cardiometabolic goals. J. Hypertens. 2019;37:1393–1400. doi: 10.1097/hjh.0000000000002065.
    1. Williams B., Mancia G., Spiering W., Agabiti Rosei E., Azizi M., Burnier M. ESC/ESH guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) Eur. Heart J. 2018;39:3021–3104. doi: 10.1093/eurheartj/ehy339. 2018.
    1. Scott D.L., Wolfe F., Huizinga T.W. Rheumatoid arthritis. Lancet. 2010;376:1094–1108. doi: 10.1016/s0140-6736(10)60826-4.
    1. Mittal T., Rathi M. Rheumatological diseases and kidneys: a nephrologist's perspective. Int. J. Rheum. Dis. 2014;17:834–844. doi: 10.1111/1756-185x.12424.
    1. Boers M., Croonen A.M., Dijkmans B.A., Breedveld F.C., Eulderink F., Cats A. Renal findings in rheumatoid arthritis: clinical aspects of 132 necropsies. Ann. Rheum. Dis. 1987;46:658–663.
    1. Koivuniemi R., Paimela L., Suomalainen R., Leirisalo-Repo M. Renal diseases in patients with rheumatoid arthritis. Scand. J. Rheumatol. 2016;45:432–433. doi: 10.3109/03009742.2016.1143966.
    1. Saisho K., Yoshikawa N., Sugata K., Hamada H., Tohma S. Prevalence of chronic kidney disease and administration of RA-related drugs in patients with RA: the NinJa 2012 study in Japan. Mod. Rheumatol. 2016;26:331–335. doi: 10.3109/14397595.2015.1088620.
    1. Couderc M., Tatar Z., Pereira B., Tiple A., Gilson M., Fautrel B. Prevalence of renal impairment in patients with rheumatoid arthritis: results from a cross-sectional multicenter study. Arthritis Care Res. 2016;68:638–644. doi: 10.1002/acr.22713.
    1. Chiu H.Y., Huang H.L., Li C.H., Chen H.A., Yeh C.L., Chiu S.H. Increased risk of chronic kidney disease in rheumatoid arthritis associated with cardiovascular complications - a national population-based cohort study. PloS One. 2015;10 doi: 10.1371/journal.pone.0136508.
    1. Tishko A.N., Lapin S.V., Vavilova T.V., Totolian A.A. Early diagnostics of kidney damage in longstanding rheumatoid arthritis and amyloidosis. Amyloid. 2011;18(Suppl 1):217–218. doi: 10.3109/13506129.2011.574354081.
    1. Sato H., Kuroda T., Tanabe N., Ajiro J., Wada Y., Murakami S. Cystatin C is a sensitive marker for detecting a reduced glomerular filtration rate when assessing chronic kidney disease in patients with rheumatoid arthritis and secondary amyloidosis. Scand. J. Rheumatol. 2010;39:33–37. doi: 10.3109/03009740903042402.
    1. Hayashi T., Ito S., Goto D., Matsumoto I., Sumida T. Elevated level of serum cystatin-C concentration is a useful predictor for myelosuppression induced by methotrexate for treatment of rheumatoid arthritis. Mod. Rheumatol. 2010;20:548–555. doi: 10.1007/s10165-010-0315-5.
    1. Kapoor T., Bathon J. Renal manifestations of rheumatoid arthritis. Rheum. Dis. Clin. N. Am. 2018;44:571–584. doi: 10.1016/j.rdc.2018.06.008.
    1. Sumida K., Molnar M.Z., Potukuchi P.K., Hassan F., Thomas F., Yamagata K. Treatment of rheumatoid arthritis with biologic agents lowers the risk of incident chronic kidney disease. Kidney Int. 2018;93:1207–1216. doi: 10.1016/j.kint.2017.11.025.
    1. Douville P., Martel A.R., Talbot J., Desmeules S., Langlois S., Agharazii M. Impact of age on glomerular filtration estimates. Nephrol. Dial. Transplant. 2009;24:97–103. doi: 10.1093/ndt/gfn473.
    1. Stuveling E.M., Hillege H.L., Bakker S.J., Gans R.O., De Jong P.E., De Zeeuw D. C-reactive protein is associated with renal function abnormalities in a non-diabetic population. Kidney Int. 2003;63:654–661. doi: 10.1046/j.1523-1755.2003.00762.x.
    1. Lipsky P.E., van der Heijde D.M., St Clair E.W., Furst D.E., Breedveld F.C., Kalden J.R. Infliximab and methotrexate in the treatment of rheumatoid arthritis. anti-tumor necrosis factor trial in rheumatoid arthritis with concomitant therapy study group. N. Engl. J. Med. 2000;343:1594–1602. doi: 10.1056/nejm200011303432202.
    1. Nishimoto N., Hashimoto J., Miyasaka N., Yamamoto K., Kawai S., Takeuchi T. Study of active controlled monotherapy used for rheumatoid arthritis, an IL-6 inhibitor (SAMURAI): evidence of clinical and radiographic benefit from an x ray reader-blinded randomised controlled trial of tocilizumab. Ann. Rheum. Dis. 2007;66:1162–1167. doi: 10.1136/ard.2006.068064.
    1. Shinde C.G., Venkatesh M.P., Kumar T.M., Shivakumar H.G. Methotrexate: a gold standard for treatment of rheumatoid arthritis. J. Pain Palliat. Care Pharmacother. 2014;28:351–358. doi: 10.3109/15360288.2014.959238.
    1. Zhao S., Mysler E., Moots R.J. Etanercept for the treatment of rheumatoid arthritis. Immunotherapy. 2018;10:433–445. doi: 10.2217/imt-2017-0155.
    1. Nakano M., Ueno M., Nishi S., Suzuki S., Hasegawa H., Watanabe T. Determination of IgA- and IgM-rheumatoid factors in patients with rheumatoid arthritis with and without nephropathy. Ann. Rheum. Dis. 1996;55:520–524. doi: 10.1136/ard.55.8.520.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe