Hydroxychloroquine Use Linked to Long-Term Kidney Function Preservation in Lupus Nephritis
A retrospective longitudinal cohort study has demonstrated that hydroxychloroquine (HCQ) use is associated with significant preservation of kidney function in patients with biopsy-proven lupus nephritis (LN), including those with established chronic kidney disease (CKD). The findings support consistent HCQ use as a strategy to slow renal decline in LN.
The study included 209 patients with incident LN and tracked estimated glomerular filtration rate (eGFR) from diagnosis through follow-up. HCQ exposure was treated as a time-dependent covariate. The primary outcomes were sustained eGFR decline of ≥30% and ≥40%, and changes in eGFR slope over time.
Overall, 33% and 23% of patients experienced eGFR decline of ≥30% and ≥40%, respectively. Time-varying HCQ exposure was associated with a 60% reduced risk of ≥30% eGFR decline and a 62% reduced risk of ≥40% decline, after adjustment for propensity scores. In patients with baseline CKD stage ≥3, HCQ use was associated with a 77% lower risk of eGFR decline.
“HCQ use was associated with early and long-term benefits on kidney function in LN, including those with CKD ≥3,” the authors stated.
Additionally, HCQ reduced the annual rate of eGFR decline. Over the first 5 years following diagnosis, HCQ use was associated with a 5.12 mL/min/1.73 m² reduction in the annual slope of eGFR decline. Over 10 years, the reduction remained significant at 3.17 mL/min/1.73 m².
These findings offer clarification amid previously conflicting data on HCQ’s renal benefits in LN and underscore the importance of long-term HCQ adherence.
“Universal HCQ use should be encouraged in patients with LN,” the authors concluded, reinforcing its role as a cornerstone in lupus nephritis management.
Reference
Garg S, Rovin B, Astor BC, et al. Hydroxychloroquine associated with lower glomerular filtration rate decline in lupus nephritis. Arthritis Care Res (Hoboken). Published online July 20, 2025. doi:10.1002/acr.25616
