RESEARCH - Renal disease as a predictor of increased mortality among patients with RA

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Nephron Clin Pract. 2004;96(4):c107-14.

Renal disease as a predictor of increased mortality among patients with

rheumatoid arthritis.

Sihvonen S, Korpela M, Mustonen J, Laippala P, Pasternack A.

Department of Internal Medicine, Tampere University Hospital, Tampere,

Finland. susanna.sihvonen@...

AIMS AND METHODS: Mortality among RA patients and controls was analyzed

with special attention to renal disease in population-based material

(originally screened in 1988) of 604 patients with RA (470 females, 134

males) and 457 age- and sex-matched controls (352 females, 105 males).

In the original RA population, isolated hematuria (HU) was observed in

54, isolated proteinuria (PU) in 27, combined hematuria and proteinuria

(HUPU) in 7, chronic renal failure (CRFtot) in 36 and isolated chronic

renal failure without HU or PU (CRFisol) in 15 patients. Among the

controls, HU was observed in 39, PU in 11, CRFtot in 32 and CRFisol in

16 subjects. HUPU was not observed in any of the controls.

Microalbuminuria (20-200 microg/min) was observed in 34 RA patients and

in 27 controls. Histologically confirmed amyloidosis was found in 13 RA

patients and mesangial glomerulonephritis (MesGN) in 17 patients. The

mortality was evaluated in 1999 from data of the Statistical Office of

Finland. Statistical analysis was performed by regression analysis.

RESULTS: Mortality was significantly increased in the RA population as

compared to controls: hazard ratio (HR) 1.78 (95% CI 1.34-2.31) for all

RA patients; HR 2.12 (1.52-2.94) for females; HR 1.15 (0.75-1.77) for

males. In the RA material, increased mortality was detected in patients

with HUPU (HR 4.45; 1.54-12.84), PU (HR 3.54; 1.88-6.65), CRFtot (HR

3.74; 2.55-5.56) or microalbuminuria (HR 2.77; 1.64-4.69) when compared

to those with normal clinical renal findings, whereas HU (HR 1.49;

0.88-2.52), CRFisol (HR 1.71; 0.82-3.54), bacteriuria (HR 0.96;

0.35-2.59) or pyuria (HR 0.65; 0.09-4.65) did not predict mortality.

Renal amyloidosis was associated with an over twofold mortality rate (HR

2.31; 1.03-5.15), whereas mortality was within expected limits in RA

patients with MesGN (HR 1.61; 0.49-5.24).

CONCLUSION: Our results show that nephropathy presenting with combined

hematuria and proteinuria, proteinuria, microalbuminuria or

histologically confirmed amyloidosis is associated with increased

mortality in RA patients, whereas mortality is within expected limits in

those with isolated hematuria or mesangial glomerulonephritis. Copyright

2004 S. Karger AG, Basel

PMID: 15122064

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=15122064 & itool=iconabstr

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