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Prognostic significance of hypertension at the onset of lupus nephritis in Chinese patients: prevalence and clinical outcomes

Journal of Human Hypertension volume 36, pages 153–162 (2022)Cite this article

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Abstract

The demographic features, and clinical and histological characteristics of lupus nephritis (LN) patients with hypertension in the Chinese population remain unclear. Hence, the clinical characteristics of LN with and without hypertension were retrospectively analyzed. A total of 764 LN patients (53.1%) were hypertensive. These hypertensive patients had higher levels of serum creatinine and blood urea nitrogen, and lower estimated glomerular filtration rates, when compared to their normotensive counterparts (P < 0.05). Furthermore, these hypertensive patients had higher median acuity index and chronicity index scores, when compared to normotensives (P < 0.001). In terms of histology, hypertensive patients were more likely to develop glomerular sclerosis, thickened glomerular capillary loops, or crescent formations, and had more severe endothelial cell proliferation, when compared to normotensive patients (P < 0.001). Hypertensive patients also had a higher percentage for more severe tubular atrophy, interstitial inflammatory cell infiltration and interstitial fibrosis (P < 0.001). Compared with normotensive patients, hypertensive patients exhibited a significant decline in survival time and rate for all end points (P < 0.01). The presence of hypertension was an independent predictor of mortality (P = 0.009), ESRD (P = 0.026), and doubling of serum creatinine (P = 0.017). In conclusion, hypertension is associated with poor clinical and renal outcome in LN patients. The monitoring and control of hypertension should be considered an important clinical goal in the treatment of LN patients.

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Fig. 1: The flowchart of the study.
Fig. 2: The Kaplan–Meier survival curves with respect to the presence of hypertension in LN patients.
Fig. 3: The restricted cubic spline model of the values of SBP/DBP/MBP was used to predict the hazard of the end points (death, ESRD and doubling of creatinine).

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Acknowledgements

This work was supported by grants from the Chinese National Key Technology R and D Program, Ministry of Science and Technology (No. 2017YFC0907601, No. 2017YFC0907602, and No. 2017YFC0907603, No. 2016YFC0906100, No. 2016YFC0906101); National Natural Science Foundation of China (No. 81970599); Natural Science Foundation of Guangdong Province (No. 2018A030313880); Guangzhou Municipal Program of Science and Technology (No. 201804020049); Key Laboratory of National Health Commission, and Key Laboratory of Nephrology, Guangdong Province, Guangzhou, China (Nos. 2002B60118 and 2017B030314019).

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  1. These authors contributed equally: Rong Rong, Qiong Wen

Authors and Affiliations

  1. Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

    Rong Rong, Qiong Wen, Yating Wang, Yagui Qiu, Miaoqing Lu, Xiaotian Liu, Wei Chen & Xueqing Yu

  2. Key Laboratory of National Health Commission, Guangzhou, China

    Rong Rong, Qiong Wen, Yating Wang, Yagui Qiu, Miaoqing Lu, Xiaotian Liu, Wei Chen & Xueqing Yu

  3. Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China

    Rong Rong, Qiong Wen, Yating Wang, Yagui Qiu, Miaoqing Lu, Xiaotian Liu, Wei Chen & Xueqing Yu

  4. Department of Medical Education, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

    Rong Rong

  5. Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

    Qian Zhou

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Rong, R., Wen, Q., Wang, Y. et al. Prognostic significance of hypertension at the onset of lupus nephritis in Chinese patients: prevalence and clinical outcomes. J Hum Hypertens 36, 153–162 (2022). https://doi.org/10.1038/s41371-021-00492-w

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