In patients with rheumatoid arthritis, treatment with biologic agents is associated with a lower risk of declining renal function and chronic kidney disease (CKD), reports a study in Kidney International.
Using a Department of Veterans Affairs database, the researchers identified 20,757 veterans diagnosed with RA between 2004 and 2006, with follow-up to 2013. All included patients had initially normal kidney function: estimated glomerular filtration rate (eGFR) 60 mL/min/1.73 m2 or higher. Treatment with biologic agents was examined for association with incident CKD, defined as eGFR less than 60 mL/min/1.73 m2, with at least a 25% decrease; and change in renal function, classified as <−3, −3, <0 (reference), and ≥0 mL/min/1.73 m2. Treatment and control groups were propensity-matched, based on their likelihood of initiating biologic treatment.
Overall, 22% of patients received biologic agents: most commonly etanercept, followed by adalimumab and infliximab. Patients receiving biologic therapy were younger and less likely to be male and African American. They also had higher eGFR, higher income, and less comorbidity.
Biologic therapy was associated with a lower incidence of CKD: hazard ratio 0.95 for a cutoff of under 60 mL/min/1.73 m2 and 0.71 for under 45 mL/min/1.73 m2. Patients receiving biologics were also less likely to have progressive eGFR decline: multinomial odds ratio 0.67 for an eGFR slope <−3 mL/min/1.73 m2 and 0.76 for ≥0 mL/min/1.73 m2 (relative to −3 to <0). The yearly rate of eGFR decline slowed from −1.0 mL/min/1.73 m2 before to −0.4 mL/min/1.73 m2 after biologics were started.
Patients with RA are at elevated risk of kidney disease, likely via chronic inflammation and/or exposure to nephrotoxic drugs. Newer biologic agents used to reduce systemic inflammation in RA have been shown to have beneficial effects in lowering cardiovascular risk.
This study suggests that biologic therapy reduces the risk of CKD and progressive decline in renal function in a nationwide cohort of veterans with RA. The associations are independent of known risk factors for CKD. [Sumida K, et al. Treatment of rheumatoid arthritis with biologic agents lowers the risk of incident chronic kidney disease. Kidney Int 2018. DOI: 10.1016/j.kint.2017.11.025].