End-stage renal disease due to lupus nephritis among children in the US, 1995-2006

Abstract

Purpose Little is known about the sociodemographic correlates of kidney transplantation and survival among U.S. children with lupus nephritis-associated ESRD. We aimed to identify predictors of listing for kidney transplantation (wait-listing), kidney transplantation, and mortality among children with lupus nephritis-associated ESRD. Methods Children aged 5–18 years with new onset lupus nephritis-associated ESRD were identified in the U.S. Renal Data System (1995–2006). We investigated demographic and clinical characteristics, causes of death and predictors of wait-listing, kidney transplantation, and mortality during the first 5 years of ESRD. Cox proportional hazards models were used. Results 583 children had incident lupus nephritis-associated ESRD. Mean age at ESRD onset was 16.2 years (SD 2.4); 51% were African American and 24% Hispanic. Within 5 years 292 (49%) were wait-listed, 193 (33%) received a kidney transplant and 131 (22%) died. Main causes of death were cardiopulmonary (31%) and infectious (16%). Children in the Northeast and West (vs. South) were more than twice as likely to be wait-listed (P<0.001, P<0.001) and over 50% more likely to be transplanted (P<0.04). There were fewer kidney transplants among older vs. younger (OR 0.59, P=0.009), African American vs. white (OR 0.48, P<0.001), Hispanic vs. non-Hispanic (OR 0.63, P=0.03) children, and those with Medicaid vs. private insurance (OR 0.7, P=0.03). Mortality was almost double among African American vs. white children (OR 1.83, P<0.001). Conclusions Among U.S. children with lupus nephritis-associated ESRD age, race, ethnicity, insurance and geographic region were associated with significant variation in 5-year wait-listing for kidney transplant, kidney transplantation and mortality.

Outcomes in Hospitalized Pediatric Patients With Systemic Lupus Erythematosus

“…As in the study by Hiraki et al, 15 our study identified sociodemographic disparities in SLE outcomes in the form of fixed variables (race and ethnicity). Assessment of modifiable factors such as educational level of caregivers, social support, and other psychosocial factors is beyond the scope of the PHIS.…”

“…20 In that study, which was not restricted to inpatients, $2 ICD-9 codes for glomerulonephritis, proteinuria, or renal failure each recorded .30 days apart were required for inclusion. Possible explanations for the difference include the more stringent criteria in the study by Hiraki et al 15 or the fact that the Medicaid database encompasses outpatient data as well, thus broadening the SLE population to those without severe disease (including nephritis).…”

ESRD From Lupus Nephritis in the United States, 1995–2010

“…lupus nephritis in the United States were less likely to undergo transplantation and more likely to die prematurely than white patients (23).…”

Incidence of End‐Stage Renal Disease Among Newly Diagnosed Systemic Lupus Erythematosus Patients: The Georgia Lupus Registry

“…The population-based incidence of SLE-attributed ESRD has been estimated at 3-4 per million per year (2-5). Substantial disparities have been described in population incidence of SLE-attributed ESRD, by younger age (4-6), female sex (4), black race (2, 4-6), lower socioeconomic status (SES) (7, 8), reduced access to care (9), and residence in the South (4, 6). However, there is little reliable information on the incidence of ESRD among those with SLE.…”