{
  "abstract": "Objectives Complete renal response (CRR) is the cornerstone in lupus nephritis (LN) management, as it plays a critical role in preserving kidney function and optimizing long-term renal and patient outcomes. We examined the prevalence and predictors of sustained CRR (sCRR), its association with tapering and discontinuation of immunosuppressive and glucocorticoid treatment and its impact on long-term outcomes.Methods We assessed longitudinal data from 142 inception cohort patients with biopsy-proven LN from two academic centres. We examined the prevalence of sCRR achievement (CRR for >12 consecutive months) and the impact of sCRR duration on renal flares, severe kidney function decline (>30% eGFR decline compared to baseline), a composite end-stage kidney disease (ESKD) or death outcome, and disease damage. Patients had a median 121-month follow-up, and the data were analyzed using linear, logistic, and Cox regression models.Results A total of 118 patients (83%) achieved sCRR for >12 months, 56.3% for >5 years and 20.4% for >10 years. Persistent hydroxychloroquine use (adjusted HR: 1.70, p=0.014) and absence of renal flares prior to sCRR achievement (adjusted HR: 0.33, p=0.016) were associated with shorter time to sCRR. The 5- and 10-year post-sCRR cumulative risk for renal flares was decreased for every additional year on CRR. sCRR duration rather than its mere achievement reduced the risk of >30% eGFR decline (adjusted OR: 0.81/year, p=0.015) and composite ESKD/death (adjusted HR:0.75/year, p=0.001). sCRR>12 months protected against damage accrual (adjusted beta-coef=-1.17, p<0.001).In the subgroup analysis among the patients with extended (>100 months) follow-up, sCRR>4 years protected against severe kidney function decline (adjusted OR: 0.10, p=0.005), ESKD/death (adjusted HR: 0.11, p=0.043, figure 1) and damage accrual (adjusted beta-coef=-0.81, p=0.012). The attempt to taper immunosuppressives was more common among sCRR achievers than non-achievers (90% vs. 45%, p<0.0001). At the time of achieving sCRR for 4 years, 26% (21/82) of patients were on full-dose of immunosuppressives, 44% were on tapering, 30% (25/82) had discontinued immunosuppressives and 78% had discontinued glucocorticoids.Abstract PO:09:232 Figure 1Kaplan-Meier estimates for the survival from the composite adverse outcome [progression to end-stage kidney disease (ESKD) and death], according to the achievement and duration of sCRR.Conclusions Persistent hydroxychloroquine use and absence of flares prior to sCRR are associated with shorter time to sCRR, while maintaining sCRR for >4 years protects against >30% eGFR decline, composite ESKD/death, and damage.",
  "authors": [
    {
      "affiliations": [
        "First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, Laiko Hospital, NKUA, Athens, Greece"
      ],
      "name": "Ioannis E Michelakis"
    },
    {
      "affiliations": [
        "Department of Nephrology and Renal Transplantation, Laiko Hospital, NKUA, Athens, Greece"
      ],
      "name": "Eleni Kapsia"
    },
    {
      "affiliations": [
        "Department of Nephrology and Renal Transplantation, Laiko Hospital, NKUA, Athens, Greece"
      ],
      "name": "John N Boletis"
    },
    {
      "affiliations": [
        "Department of Nephrology and Renal Transplantation, Laiko Hospital, NKUA, Athens, Greece"
      ],
      "name": "Smaragdi Marinaki"
    },
    {
      "affiliations": [
        "First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, Laiko Hospital, NKUA, Athens, Greece"
      ],
      "name": "Petros P Sfikakis"
    },
    {
      "affiliations": [
        "First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, Laiko Hospital, NKUA, Athens, Greece"
      ],
      "name": "Maria G Tektonidou"
    }
  ],
  "title": "PO:09:232 Sustained complete renal response in lupus nephritis protects against kidney function decline, composite ESKD/death and organ damage and can be achieved and maintained with reduced exposure to therapy",
  "uid": "9fb7c0ed-b18a-5a2c-8b0d-12ed75ff9b0a"
}