Journal List > J Rheum Dis > v.18(3) > 1063908

Hong, Yang, and Yoo: The Prevalence and Associated Factors of Kidney Disease in Korean Rheumatoid Arthritis Patients

Abstract

Objective

To determine the prevalence and associated factors of kidney disease in Korean rheumatoid arthritis (RA) patient, and describe the profile of RA drugs prescribed in RA patients.

Methods

A total of 284 patients at the division of rheumatology with confirmed RA were prospectively included in this study from May 1 to August 31, 2008. Renal function was assessed using Cockcroft-Gault (CG) and abbreviated Modification of Diet in Renal Disease (aMDRD) study formulae, and classified by the National Kidney Foundation (NKF) classification. Comparisons was were performed by the two sample t-test, chi-square-test and binary logistic regression analysis.

Results

Of 281 patients with RA, only 7 (2.5%) patients had abnormal serum creatinine (sCr) levels. According to the NFK classification, the prevalence of kidney disease using aMDRD and CG formula was 23.8% and 31.7%, respectively. Among the patients with eGRF <60 mL/min/m2 according to aMDRD or CG formulae, 91.8∼100% received at least one drug that was potentially nephrotoxic. RA patients with renal dysfunction was associated with advanced age, body mass index (BMI), antinuclear antibody (ANA).

Conclusion

Estimation of renal function with CG or aMDRD formulae is important in RA patients, particularly in those with low BMI or old age. Also, appropriate dosage adjustment is needed in patients with renal dysfunction.

References

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Table 1.
Demographic and clinical characteristics of the patients
Variable  
Age 55.7±11.9
Gender, n (%)
  Male 65 (23.1)
  Female 216 (76.9)
ESR (mm/hour) 35.7±24.6
CRP (mg/L) 8.9±15.9
BMI (kg/m2) 22.5±3.6
Disease duration (years) 7.2±6.3
DAS28 3.3±1.1
HAQ-DI 0.58±0.71
Positive ANA, n (%) 52 (18.5)
Positive RF, n (%) 226 (80.4)

Data are presented as n (%) or mean± SD. ESR: erythrocyte sedimentation rate, CRP: c-reactive protein, BMI: body mass index, DAS28: disease activity score 28, HAQ-DI: health assessment questionnaire-disability index, ANA: antinuclear antibody, RF: rheumatoid factor.

Table 2
Prevalence of kidney disease in patients with rheumatoid arthritis according to National Kidney Foundation classification
Stage GFR (mL/min/1.73 m2) aMDRD fomula Cock-Croft Gault formula
n (%) No. of abnormal Cr n (%) No. of abnormal Cr
Normal ≥60 without evidence of kidney damage 214 (76.2) 0 192 (68.3) 0
Stage 1 ≥90+Kidney damage 36 (12.8) 0 24 (8.5) 0
Stage 2 60∼89+Kidney damage 11 (3.9) 0 17 (6.0) 0
Stage 3 30∼59 16 (5.7) 3 44 (15.7) 3
Stage 4 15∼29 1 (0.4) 1 3 (1.1) 3
Stage 5 <15 3 (1.1) 3 1 (0.4) 1

Kidney damage is defined as pathologic abnormalities or markers of damage, including abnormalities in blood or urine tests or imaging studies.

Table 3.
Comparison of demographic, clinical, and laboratory features (eGFR calculated by CG formula)
Variables GFR≥60 mL/min/1.73 m2(n=233) GFR<60 mL/min/1.73 m2(n=48) p-value
General demographics
  Age, years 53.5±11.4 66.8±7.8 <0.001
    ≥65 45 (19.3) 35 (72.9) <0.001
    <65 188 (80.7) 13 (27.1)  
  Gender, n (%)     0.678
    Male 55 (23.6) 10 (20.8)  
    Female 178 (76.4) 38 (79.2)  
  BMI (kg/m2) 22.7±3.6 21.2±3.4 0.010
  Diabetes, n (%) 34 (14.6) 9 (18.8) 0.466
  Hypertension, n (%) 72 (30.9) 24 (50.0) 0.011
RA characteristics      
  RF positive, n (%) 184 (79.0) 42 (87.5) 0.231
  ANA positive, n (%) 36 (15.5) 16 (33.3) 0.007
  Disease duration, years 6.8±6.1 9.1±7.3 0.023
  CRP, mg/L 8.7±16.0 9.7±15.9 0.714
  ESR, mm/hr 34.1±23.9 43.6±26.7 0.014
  DAS 28 3.22±1.09 3.48±1.10 0.128
    Low (≤3.2) 129 (55.4) 19 (39.6) 0.057
    Moderate to high (>3.2) 104 (44.6) 29 (60.4)  
  HAQ-DI 0.51±0.65 0.92±0.86 0.003
Medication      
  Steroid, n (%)     0.163
    ≤7.5 mg 221 (94.8) 43 (89.6)  
    >7.5 mg 12 (5.2) 5 (10.4)  
  NSAIDs, n (%) 184 (79.0) 35 (72.9) 0.357
  MTX, n (%) 153 (65.7) 27 (56.3) 0.216
  Leflunomide, n (%) 151 (64.8) 36 (75.0) 0.173

Data are presented as n (%) or mean± SD. GFR: glomerular filtration rate, CG: Cock-Croft Gault formula, BMI: body mass index, RA: rheumatoid arthritis, RF: rheumatoid factor, ANA: antinuclear antibody, CRP: c-reactive protein, ESR: erythrocyte sedimentation rate, DAS28: disease activity score 28, HAQ-DI: health assessment questionnaire-disability index, NSAIDs: non-steroid antiinflammatory drugs, MTX: methotrexate.

Table 4
Multivariate analysis of independent factors associated with decreased creatinine clearance (<60 mL/min/m2) in patients with rheumatoid arthritis
Independent factors B p-value OR (95% CI)
Age>65 years 2.601 <0.0011 3.478 (6.213∼29.239)
Positive ANA 1.156 0.007 3.176 (1.382∼7.302)
BMI −0.137 0.004 0.872 (0.794∼0.958)

ANA: antinuclear antibody, BMI: body mass index.

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