RESEARCH - Kidney disease in RA patients: prevalence and implication on RA-related drugs management: MATRIX

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Rheumatology Advance Access published online on January 31, 2008

Rheumatology, doi:10.1093/rheumatology/kem370

Kidney disease in RA patients: prevalence and implication on

RA-related drugs management: the MATRIX study

S. Karie1, F. Gandjbakhch2, N. Janus1, V. Launay-Vacher1, S.

Rozenberg2, C. U. Mai Ba1, P. Bourgeois2 and G. Deray1

1Department of Nephrology and 2Department of Rheumatology,

Pitié-Salpêtrière Hospital, Paris, France.

Abstract

Objectives. The prevalence of kidney disease (KD) indicators together

with the profile of RA drugs prescribed in RA patients was

investigated in the MATRIX study (MeThotreXate And Renal

Insufficiency).

Methods. Renal function (RF) was assessed using Cockcroft–Gault (CG)

and abbreviated Modification of Diet in Renal Disease (aMDRD) study

formulae.

Results. Serum creatinine (SCr) was normal in 81.4% of the 129

patients included. According to the National Kidney Foundation (NKF)

classification, the distribution by stage of KD was, using the aMDRD

and CG formulae, as follows: stage 1: 11.3% and 11.4%; stage 2: 20.0%

and 20.3%; stage 3: 15.0% and 24.1%; stage 4: 0% and 1.3%; stage 5:

0%. Proteinuria, haematuria and leucocyturia were observed in 16%, 17%

and 20% of the patients, respectively. Using the aMDRD and CG

formulae, 36% and 38% of the prescriptions made in patients with

glomerular filtration rate (GFR) <60 ml/min required a dosage

adjustment. Among the patients with GFR <60 ml/min, 83–90% received at

least one drug that required a dosage adjustment and 67–70% received

at least one drug that was potentially nephrotoxic, according to aMDRD

or CG formulae, respectively. Five (50%) and 8 (47%) patients did not

have appropriate MTX dosage adjustment according to their stage of KD

with aMDRD or CG formulae, respectively.

Conclusion. Systematic estimation of RF with CG or aMDRD formulae and

urine dipstick are necessary in RA patients. In patients with KD at

high risk for drug toxicity, dosage should be adapted to RF.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/kem370v1?papetoc

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