Early RAAS blockade improves short-, long-term renal outcomes in SLE patients with aPLN
Early renin-angiotensin-aldosterone system (RAAS) blockade with renin-angiotensin system inhibitors (RASI) leads to better short- and long-term renal outcomes in systemic lupus erythematosus (SLE) patients with antiphospholipid-associated nephropathy (aPLN), according to a study, adding that this renal protective effect is independent of RASI’s antihypertensive and antiproteinuric effects.
No significant difference was observed in demographic data, laboratory findings and renal histology by the time of kidney biopsy between the RASI and non-RASI groups. However, the former showed higher proteinuria levels than the latter (5.2; 2.8–8.8 vs 1.9; 0.6–2.8 g/day; p=0.005) and higher prevalence of hypertension (75 percent vs 29 percent; p=0.001).
At 12 months after kidney biopsy, there was no significant between-group difference in estimated glomerular filtration rate (eGFR), mean arterial pressure and proteinuria. The RASI group showed significantly higher improvement ratio of eGFR vs the non-RASI group (26 percent; –5 to 86 percent vs –2 percent; –20 to 20; p=0.028). Beyond 12 months, the rate of change in eGFR was similar between the two groups.
Furthermore, kidney disease progression developed in four patients (23 percent) in the non-RASI group and three (8 percent) 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).
The two groups had comparable proteinuria and hypertension controls.
To assess the renal protective effects of RAAS with RASI, the investigators analysed medical data of 57 SLE patients with biopsy-proven aPLN. Early RAAS blockade was defined as administration of RASI within 3 months after kidney biopsy and continued for ≥12 months.