Challenges of Managing Lupus Nephritis in an Emerging Nephrology Centre: A Fijian Cohort Study.

Abstract

Aim: To characterise the epidemiology and outcomes of Lupus Nephritis (LN) in Fiji.

Methods: All adult LN cases diagnosed from 2016 to 2020 at the national referral hospital were included. Treatment response, kidney failure, dialysis dependence and death were reported.

Results: From 33 cases, a crude annual incidence of 2.44 (95% CI 1.73-3.43) per 100,000 population and an age-standardised incidence of 2.37 (95% CI 0.65-4.09) per 100,000 population was derived. The median age was 25.7 years (IQR 19.5-32) with a predominance of indigenous iTaukei ethnicity (67%). Kidney biopsy with adequate tissue was performed in 24 patients (73%), revealing LN class III in 10 patients (42%) and class IV in 14 patients (58%). Twenty-eight patients (85%) underwent induction immunosuppression, with complete and partial response in 12 patients (43%) and 2 patients (7%) at 12 months, respectively. No factor was found to be significantly associated with complete response at 12 months. At 2 years, 13 patients (39%) had developed kidney failure, 6 of whom commenced dialysis, and 13 patients (39%) had died. The risk of dialysis dependence or death was associated with suboptimal adherence to therapy (OR 12.0, 95% CI 1.23-117, p = 0.028) and 12-month complete response (OR 0.08, 95% CI 0.01-0.54, p = 0.005).

Conclusion: Fiji has a high incidence of LN and nearly half of our cohort had either died or were dialysis dependent within 2 years of diagnosis. These results will inform targeted healthcare strategies that can be implemented in Fiji and neighbouring Pacific Island countries.