Cardiometabolic Risk, Evaluation, and Control in Lupus Nephritis.

INTRODUCTION: Lupus nephritis (LN) is associated with atherosclerotic cardiovascular disease but early recognition of cardiometabolic risk in patients with LN can facilitate risk optimization with disease-modifying strategies. To identify potential gaps in cardiometabolic risk management in LN in real-world practice, we aimed to evaluate the prevalence and trend in cardiometabolic risk, evaluation, and control. METHODS: We performed a single-center, cross-sectional study of all adults with biopsy-confirmed LN between 2011 and 2022 to (1) assess the prevalence of cardiometabolic risks (age, sex, diabetes mellitus, hypertension, hyperlipidemia, ischemic heart disease [IHD], reduced kidney function [estimated glomerular filtration rate, estimated glomerular filtration rate <60 mL/min/1.73 m2], urine protein-to-creatinine ratio [UPCR] >0.15 g/g, glucocorticoid use), evaluation (office blood pressure [BP], fasting glucose and lipid and HbA1c), and control at the time of diagnosis; and then (2) evaluate the association between time periods (2019-2022 compared to 2015-2018) and cardiometabolic evaluation and control, adjusting for traditional and systemic lupus erythematosus disease-specific cardiometabolic risks in multivariable logistic regression models. RESULTS: We evaluated 326 adults with LN (median age 42.0 years [interquartile range: 30.9, 52.7]). Across the 3 time periods, reduced kidney function was most frequent in 2011-2014. Hypertension and renin-angiotensin system blocker use were lowest in 2019-2022 (23.4% and 30.9%, respectively), while 38.0% achieved BP <130/80 mm Hg without significant change across time periods. Glycemic evaluation was least frequent in 2019-2022 (78.7%) compared to earlier time periods. Achievement of glycemic targets of fasting glucose <6.1 mmol/L and HbA1c ≤7% were 70.0% and 95.1%, respectively, without significant change across the time periods. Lipid evaluation was performed in 75.8% but only 32.0% achieved low-density lipoprotein-cholesterol <2.6 mmol/L. There was no significant change in the prevalence of lipid evaluation or control over time. CONCLUSION: Glycemic assessment and optimization of BP and lipid treatment to achieve guideline-recommended targets represent opportunities to improve cardiometabolic risk management in LN.