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Hypertension and Afro-descendant ethnicity: a bad interaction for lupus nephritis treated with cyclophosphamide?

Post-Graduation Program in Medical Sciences: Nephrology, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Brazil, wcastro{at}portoweb.com.br, Department of Internal Medicine: Nephrology, Fundacao Faculdade Federal de Ciencias Medicas de Porto Alegre, Brazil, Nephrology Division, Santa Casa de Misericórdia de Porto Alegre, Brazil

J.V. Morales

Post-Graduation Program in Medical Sciences: Nephrology, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Brazil, Nephrology Division, Hospital de Clínicas de Porto Alegre, Brazil

M.B. Wagner

Post-Graduation Program in Medical Sciences: Nephrology, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Brazil

M. Graudenz

Pathology Department, Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Brazil

M.I. Edelweiss

Pathology Division, Hospital de Clínicas de Porto Alegre, Brazil

L.F. Gonçalves

Post-Graduation Program in Medical Sciences: Nephrology, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Brazil, Nephrology Division, Hospital de Clínicas de Porto Alegre, Brazil

Hypertension and ethnicity are important prognostic factors in evolution of lupus nephritis. A cohort of 75 patients with lupus nephritis treated with cyclophosphamide was conducted to investigate the evolution of creatinine levels between Caucasians and Afro-descendants. A multiple linear model was used to evaluate the combined effects of ethnicity and hypertension over delta creatinine controlling confounders. Sample characteristics were: 85% females; mean (±SD) age of 33.6 ± 12.0 years; 77% Caucasians; 40% hypertensive at renal biopsy; 91% WHO class IV; mean basal creatinine: 1.5 ± 1.3 mg/dL; mean final creatinine: 2.1 ± 2.5 mg/dL; 40% anaemia; proteinuria: 5.4 ± 4.8 g/day. Comparing Caucasians and Afro-descendants, it was found: 28.1% versus 72.2% for hypertension (P = 0.002); 31.6% versus 66.7% for anaemia (P = 0.018); 5.9 ± 5.0 versus 3.8 ± 4.0. g/day (P = 0.02) for proteinuria. Other comparisons including basal creatinine did not reach statistical significance. Comparing outcomes between Caucasians and Afro-descendants, it was found: 10.5% versus 22.2% for doubling of creatinine (P = 0.24); 0.41 ± 2.03 versus 1.05 ± 2.41 for delta creatinine ( P = 0.29); 8.8% versus 22.2% for haemodialysis (P = 0.21) and 3.5% versus 5.6% for death (P = 0.99). Analysing delta creatinine with multiple linear regression showed that hypertension had a significant overall effect (b = 0.80; SE = 0.32; P = 0.015), ethnicity alone was not significant (b = 0.35; SE = 0.29; P = 0.228); however, the effect of hypertension on delta creatinine was more intense among Afro-descendants than among Caucasians (interaction term b = — 0.83; SE = 0.37; P = 0.027). Afro-descendants lupus patients experience worst prognosis of renal function probably due to the effect of hypertension and not ethnicity per se. Lupus (2007) 16, 724—730.

Key Words: cyclophosphamide • ethnicity • hypertension • lupus nephritis • prognosis

Lupus, Vol. 16, No. 9, 724-730 (2007)
DOI: 10.1177/0961203307081114


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