The burden of chronic kidney disease in systemic lupus erythematosus: A nationwide epidemiologic study

ObjectiveTo analyze the impact of chronic kidney disease (CKD) on major clinical outcome in SLE by using a nationwide database.Patients and methodsCharacteristics of all admitted SLE patients experiencing CKD (eGFR <60 mL/min/1.73 m2) in France from 2009 to 2015 were analyzed through the French medico- administrative database. Factors associated with CKD and major clinical outcomes such as end-stage renal disease (ESRD), cardiovascular event (CVE), septic shock and death were assessed. We used a multivariate Cox proportional hazard model and subdistribution hazard models to analyze survival without major clinical events according to the presence of CKD.ResultsFrom 2009 to 2015, 26,320 SLE patients were hospitalized in France. Among them, 6439 (86.5% women; mean age 45.7 [16.5] years old) had a baseline stay in 2009 during which CKD was reported in 428 (6.7%) cases. Multivariate analysis showed that lupus nephritis (OR 6.6 [5.2–8.4]), high blood pressure (OR 3.5 [2.8–4.5]), septic shock (OR 3.2 [1.7–6.0]) and past cardiovascular history (OR 1.4 [1.0–2.0]) were associated with CKD status. From 2009 to 2015, ESRD, CVE, septic shock, and death occurred in 4.0%, 14.4%, 6.3% and 9.6% of the 6439 SLE patients. CKD at baseline was independently and strongly associated with the occurrence of ESRD (sdHR 15.9 [11.6–21.9]), CVE (sdHR 1.7 [1.4–2.2]), septic shock (sdHR 2.1 [1.5–2.8]) and death (HR 1.7 [1.3–2.2]) during the follow up.ConclusionCKD is a major risk factor for overall morbidity and mortality in SLE patients, highlighting the need for early pre-CKD lupus nephritis diagnosis and treatment.     

Vitamin D metabolism and cardiovascular risk factors in postmenopausal women

Objectives

The purpose of this review is to focus on the association of vitamin D and cardiovascular risk factors in postmenopausal women.

Methods

Review of the relevant literature and results from recent clinical studies as well as critical analysis of published results concerning the association of vitamin D and cardiovascular risk factors in postmenopausal women obtained from both a PubMed and individual searches.

Results and discussion

Both basic science and clinical studies support the protective role of vitamin D on cardiovascular health, although there are controversial results in the literature. Hypovitaminosis D is associated with disturbed glucose metabolism and pancreatic β-cell dysfunction, lipoprotein alterations, hypertension, overweight and obesity. The evidence highlights the importance of improving vitamin D status in the general population for the prevention of adverse long-term health risks, including cardiovascular health. The optimal vitamin D dose remains to be determined. However, correction of low vitamin D itself does not guarantee the prevention of these conditions.