{
  "abstract": "Introduction Systemic sclerosis (SSc) is characterised by a variable multi-organ involvement. Renal manifestations result from a multifactorial pathogenesis, presenting as hypertension, proteinuria, and/or loss of glomerular filtration rate (GFR). Chronic kidney disease (CKD) in SSc has been demonstrated in 70% of patients at autoptic studies, however, no reliable biomarker for SSc-CKD exists and limited evidence supporting the use of estimated (e)GFR for renal screening are available. This study aimed to investigate the impact of an impaired eGFR at diagnosis of SSc, on clinical course and prognosis of patients.Material and Methods Consecutive patients fulfilling the 2013 ACR/EULAR classification criteria for SSc, with at least two renal function assessments, including eGFR calculation with the Cockcroft-Gault equation, were included. Patients with an eGFR<60 ml/min/1.73m2 at baseline were considered as having ‘impaired’ renal function, while those with higher values were classified as having ‘preserved’ function, according to the updated Kidney Disease Improving Global Outcomes classification system. Data were retrospectively collected from medical charts, at baseline and last observation, to assess disease course and prognosis, and analyzed using the SPSS (v.26) software with appropriate statistical tests.Results A total of 395 SSc patients (female 90%, median age 65 years) were included, and 30% of them had an ‘impaired’ eGFR at diagnosis of SSc ( table 1). Patients with an ‘impaired’ eGFR were significantly older (p<0.0001) and had a longer disease duration (p<0.0001) than those with a ‘preserved’ eGFR. SSc patients with a decreased eGFR had significantly higher frequency of pulmonary hypertension (p<0.0001), pericardial effusions (p=0.003), active digital ulcers (p=0.04) and calcinosis (p=0.001), but lower DLCO (p=0.003), total cholesterol (p<0.0001) and BMI (p<0.0001), than patients with preserved eGFR. Finally, significantly higher creatinine (p<0.0001), azotemia (p<0.0001), uric acid (p=0.02) and NT-proBNP (p<0.0001) levels were observed in SSc patients with a reduced eGFR at baseline. Treatment with calcium channel blockers (p<0.0001) and immunosuppressors (p<0.01) was more frequent in SSc patients with preserved renal function, while steroids were less frequent (p=0.0006). At logistic regression analyses, a baseline impaired eGFR was confirmed a significant negative prognostic factor for survival (table 2, figure 1).Conclusions SSc-CKD patients have almost a three-fold higher mortality risk in comparison to patients with a preserved eGFR, and are characterized by a higher frequency of cardiopulmonary involvement and calcinosis, but lower BMI and cholesterol levels. Treatment with calcium channel blockers is associated with preserved renal function. These findings highlight the importance of adequate baseline renal function screening with appropriate and early treatment interventions.Abstract P.352 Table 1Baseline demographic and clinical data of SSc patients with and without impaired renal function (eGFR<60 ml/min/1.73m2)Abstract P.352 Figure 1Prognosis based on KDIGO-stage of renal function at diagnosis of SScAbstract P.352 Table 2Univariate and multivariate logistic regression analyses of survival in SSc patients",
  "authors": [
    {
      "affiliations": [
        "Rheumatology Unit - Department of Precision and Regenerative Medicine, Jonian Area (DiPReMeJ), University of Bari ‘Aldo, Bari",
        "LUM ‘G. Degennaro’ - Department of Medicine and Surgery, Casamassima, Italy., Casamassima"
      ],
      "name": "Stefano Stano"
    },
    {
      "affiliations": [
        "Rheumatology Unit - Department of Precision and Regenerative Medicine, Jonian Area (DiPReMeJ), University of Bari ‘Aldo, Bari",
        "Rheumatology Unit - F. Miulli General Hospital, Department of Medicine and Surgery, LUM G. Degennaro, Casamassima, Italy"
      ],
      "name": "Fabio Cacciapaglia"
    },
    {
      "affiliations": [
        "Rheumatology Unit - Department of Precision and Regenerative Medicine, Jonian Area (DiPReMeJ), University of Bari ‘Aldo, Bari"
      ],
      "name": "Giorgia Campanale"
    },
    {
      "affiliations": [
        "Rheumatology Unit - Department of Precision and Regenerative Medicine, Jonian Area (DiPReMeJ), University of Bari ‘Aldo, Bari"
      ],
      "name": "Simone Perniola"
    },
    {
      "affiliations": [
        "Rheumatology Unit - Department of Precision and Regenerative Medicine, Jonian Area (DiPReMeJ), University of Bari ‘Aldo, Bari"
      ],
      "name": "Mariangela Nivuori"
    },
    {
      "affiliations": [
        "Rheumatology Unit - Department of Precision and Regenerative Medicine, Jonian Area (DiPReMeJ), University of Bari ‘Aldo, Bari"
      ],
      "name": "Angelica Napoletano"
    },
    {
      "affiliations": [
        "Rheumatology Unit - Department of Precision and Regenerative Medicine, Jonian Area (DiPReMeJ), University of Bari ‘Aldo, Bari"
      ],
      "name": "Marco Fornaro"
    },
    {
      "affiliations": [
        "Rheumatology Unit - Department of Precision and Regenerative Medicine, Jonian Area (DiPReMeJ), University of Bari ‘Aldo, Bari"
      ],
      "name": "Florenzo Iannone"
    }
  ],
  "title": "P.352 From crisis to chronicity: a real-world study of renal dysfunction in systemic sclerosis",
  "uid": "fe6631e0-c04e-5ce3-9cc8-b39b27ee6c0b"
}