Early RAAS blockade improves renal outcomes in SLE patients with aPLN
Short- and long-term renal outcomes improve with early renin–angiotensin–aldosterone system (RAAS) blockade with renin–angiotensin system inhibitors (RASI) in systemic lupus erythematosus (SLE) patients with antiphospholipid-associated nephropathy (aPLN), according to a study.
“The renal protective effect of RASI was independent of its antihypertensive and antiproteinuric effects,” the investigators said.
Demographic data, laboratory findings and renal histology by the time of kidney biopsy had no significant difference, but the RASI vs the non-RASI group had higher proteinuria levels (5.2; 2.8–8.8 vs 1.9; 0.6–2.8 g/day, respectively; p=0.005) and higher prevalence of hypertension (75 percent vs 29 percent, respectively; p=0.001).
There was no significant between-group difference in estimated glomerular filtration rate (eGFR), mean arterial pressure and proteinuria level at 12 months after kidney biopsy.
The RASI group had significantly higher improvement ratio of eGFR at 12 months compared with the non-RASI group (26 percent; –5 to 86 percent vs –2 percent; –20 to 20 percent, respectively; p=0.028). The rate of change in eGFR beyond 12 months was comparable between the two groups.
Kidney disease progression occurred in four (23 percent) patients in the non-RASI group and three (8 percent) patients in the RASI group during a mean follow-up of 80 months. Early RAAS blockade significantly reduced the risk of kidney disease progression (hazard ratio, 0.11; 0.02–0.59; p=0.010). Additionally, the two groups had similar proteinuria and hypertension controls.
In this study, the investigators analysed medical data of 57 SLE patients with biopsy-proven aPLN. Early RAAS blockade referred to the administration of RASI within 3 months following kidney biopsy and continued for ≥12 months.