Effect of anti-tumor necrosis factor alpha treatment of rheumatoid arthritis and chronic kidney disease

초록

Although chronic kidney disease (CKD) may constitute a chronic inflammatory state indicated by elevated inflammatory mediators such as tumor necrosis factor alpha (TNF-alpha), the impact of anti-TNF-alpha therapy on progression of CKD in patients with rheumatoid arthritis (RA) is unclear. Seventy patients with RA and CKD were retrospectively analyzed. Outcomes were evaluated using the difference in the annual change of estimated glomerular filtration rate (eGFR) between patients treated with anti-TNF-alpha or without. Anti-TNF-alpha therapy significantly decreased disease activity score (DAS) 28 from 5.32 +/- A 0.78 to 3.59 +/- A 0.85 (p < 0.001). There was a tendency toward stabilization of eGFR after a mean of 2.9 +/- A 1.1 years from 50.3 +/- A 8.4 ml/min/1.73 m(2) to 54.5 +/- A 16.0 ml/min/1.73 m(2) in patients received anti-TNF-alpha therapy along with decreased DAS28 (p = 0.084). Conversely, eGFR decreased significantly in patients not receiving anti-TNF-alpha therapy after a mean of 2.8 +/- A 1.7 years from 52.6 +/- A 7.5 ml/min/1.73 m(2) to 46.5 +/- A 11.5 ml/min/1.73 m(2) (p = 0.041) without significant DAS28 change (p = 0.078). The annual change of eGFR was significantly different between patients treated with anti-TNF-alpha drugs and without (2.0 +/- A 7.0 ml/min/1.73 m(2)/year vs. -1.9 +/- A 4.0 ml/min/1.73 m(2)/year; difference in mean vs. -3.9 +/- A 7.3 ml/min/1.73 m(2)/year; p = 0.006). Use of anti-TNF-alpha drugs was significantly associated with positive annual change of eGFR in multivariate logistic regression analysis (p = 0.019). Among patients with RA and CKD, treatment with anti-TNF-alpha drugs was associated with less renal function decline. Anti-TNF-alpha drugs may be beneficial for managing RA combined with CKD.

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