OBJECTIVES: LN, a common manifestations of Lupus, often progresses to Chronic Kidney Disease (CKD) or End Stage Renal disease (ESRD) within 5 years of LN diagnosis. Early identification and monitoring could possibly delay the progression to CKD/ESRD in LN patients. The objective is to evaluate disease progression among LN patients in the real-world.

METHODS: Patients with ≥2 records for lupus (ICD10) between 01/01/2016 and 31/12/2020 were identified using Optum de-identified electronic health records. The first record for lupus was set as index. Patients with continuous activity 6 months pre and 24 months post-index, with no lupus diagnosis during the pre-index were included. Patients were followed up to 24 months to assess evidence of LN (second index; based on ICD codes for proteinuria, nephritis, glomerular diseases, and renal failure). Patients were further followed for 12 months from LN diagnosis date to assess the progression to CKD/ESRD. We also evaluated the use of guideline recommended therapies and progression among the subset of patients with LN.

RESULTS: A total of 37,163 patients with lupus were identified after applying the study selection criterion. Nearly 8% of patients presented with LN at the time of lupus diagnosis. Approximately, 14% and 19% of patients developed LN in the first 12 months and 24 months of lupus diagnosis, respectively. Among patients who developed LN, nearly 41% progressed to CKD/ESRD within a year of diagnosis irrespective of their treatment status. Approximately, 60% patients progressed to CKD/ESRD during the 12 months follow-up period even after receiving the guideline recommended therapy.

CONCLUSIONS: Our analysis suggests that lupus patients may develop LN as early as 1 year of diagnosis, and subsequently to CKD/ESRD in a year. Well designed studies using EHR may provide greater insights into the factors associated with early progression, which will help design population health initiatives targeting early detection and intervention.