PREVALENCE AND PREDICTORS OF COGNITIVE DYSFUNCTION IN PATIENTS WITH LUPUS NEPHRITIS: A CROSS-SECTIONAL COMPARISON WITH PATIENTS WITH OTHER CHRONIC KIDNEY DISEASES

BackgroundCognitive dysfunction (CD) is among the most frequent neuropsychiatric manifestation of systemic lupus erythematosus (SLE) that has a considerable impact on quality of life, but still lacks adequate screening in clinical routine.ObjectivesOur aim was to investigate the distribution and determinants of CD in patients with lupus nephritis, and to compare cognitive function with that in patients with other forms of glomerular chronic kidney disease (CKD) by the Montréal Cognitive Assessment (MoCA).MethodsWe carried out a cross-sectional case-control study with consecutive patients with SLE who fulfilled the 2012 SLICC (Systemic Lupus International Collaborating Clinics) classification criteria(1) and have history of lupus nephritis, using a similarly derived CKD control population matched by age and sex, to assess cognitive function using MoCA scale(2). CD was defined as score < 26/30, adjusted for duration of formal education. Demographic data and disease characteristics were collected. SLE disease activity was evaluated by using Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI2K) (3). The effect of disease-related parameters on the MoCA was examined by regression analysis.ResultsA total of 35 patients with SLE and 35 CKD controls were included in our study (Table 1). Among SLE patients, 7 (20%) patients had biopsy proven active nephritis, 7 (20%) had kidney failure and one a kidney transplant. CD according to MoCA score was found in 64.2% (n=45) patients (Figure 1). The proportion of patients with CD according to MoCA between patients with lupus nephritis and CKD controls was not statistically significant (62.8% vs 65.7%, p>0.05). SLE patients performed bad in all cognitive domains. Memory, abstraction and language skills were the most affected domains. Our study showed that active nephritis and disease duration were associated with poor cognitive performance (OR=1.4, p = 0.03; OR=1.2, p = 0.03). GFR values and other parameters evaluated (end stage renal disease, damage, age at diagnosis, use of glucocorticoids, hydroxychloroquine and immunosuppressive drugs) had no significant effect on development of CD in SLE patients.Table 1.Demographics and clinical characteristics of SLE patientsmean%Age44Women94.2Education>16 yrs51.416 -13 yrs37.1<13 yrs11.4Disease duration (yrs)16Kidney failure20Prednisone (% use)<20 mg11.4≥20mg88.5Hydroxychloroquine (% use)65.7Immunosuppressants (% use)57.1SLEDAI2.4SDI0.8Figure 1.Montréal Cognitive Assessment (MoCA) results in patients with systemic lupus erythematosus (SLE) compared to hemodialysis and chronic kidney disease (CKD) patients.ConclusionIn this study, two thirds of SLE patients had CD. Patients with lupus nephritis have comparable cognitive function than patients with other CKD. Decline in renal function was not associated with CD in SLE, suggesting that the CD in this population may represent a consequence of lupus itself rather than kidney-related central nervous system damage.References[1]Petri M, et al. Arthritis Rheum. 2012[2]Nasreddine ZS, et al. J Am Geriatr Soc 2005[3]Gladman DD, et al. J Rheumatol. 2002Disclosure of InterestsNone declared