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

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.