Racial and Ethnic Differences in Mortality and Cardiovascular Events Among Patients With End‐Stage Renal Disease Due to Lupus Nephritis

Abstract

Objective To identify racial and ethnic differences in mortality and cardiovascular (CV) risk among patients with end-stage renal disease (ESRD) due to lupus nephritis (LN) Methods Within the U.S. ESRD registry (1995-2008), we identified individuals aged >17 years with incident ESRD due to systemic lupus erythematosus (SLE). We ascertained demographics, clinical factors, and deaths from registry patient files and CV events (myocardial infarction, heart failure, hemorrhagic and ischemic strokes) from inpatient Medicare claims. We calculated incidence rates [95% confidence intervals (CI)] per 1,000 person-years for study events, stratified by race and ethnicity. We compared probabilities of the events among racial/ethnic groups using cumulative incidence function curves and multivariable-adjusted sub-distribution proportional hazard ratios (HRsd), taking into account the competing events of kidney transplantation and death (for non-fatal CV events). Results Of 12,533 patients with LN ESRD, mean age was 40.7 ± 14.9 years; 82% were women and 49% African Americans. The overall mortality rate was 98.1/1,000 persons-years (95%CI 95.3-100.9). In multivariable models, Asian and Hispanic LN ESRD patients had lower mortality than Whites [HRsd 0.70 (95%CI: 0.58-0.84) and 0.79 (95%CI: 0.71-0.88)], whereas African Americans had higher mortality [HRsd 1.27 (95%CI: 1.18-1.36)]. African American patients under age 40 had higher mortality than their White counterparts [HRsd 1.67 (95 %CI:1.44-1.93)]. African Americans were more likely to be admitted for heart failure or hemorrhagic stroke. Conclusion Among patients with LN ESRD, Asians and Hispanics experienced lower mortality and CV event risks, while African Americans had higher mortality and CV event risks compared to Whites.

Sex Differences in Health Care Utilization, End‐Stage Renal Disease, and Mortality Among Medicaid Beneficiaries With Incident Lupus Nephritis

“…Our Medicaid data were linked to USRDS, which captures nearly all ESRD cases in the US. While our findings may not be generalizable to all populations, we focused our study on a large, vulnerable, and diverse patient population, shown in other studies to have an excess burden of adverse outcomes, receiving care at both academic centers and non-academic centers (23,36,37). With 10 years of data and a mean follow-up of In this large, nationwide study of Medicaid beneficiaries with incident LN, we found extremely high rates of ESRD and mortality but no statistically significant differences by sex in these outcomes.…”

Infiltrating CD16+Are Associated with a Reduction in Peripheral CD14+CD16++Monocytes and Severe Forms of Lupus Nephritis

“…Lupus nephritis (LN) is one of the hallmark features of SLE, seen in 40%–60% of patients at the moment of diagnosis, and is one of main causes of mortality among these patients [1]. Among 10 to 15% can develop an end stage renal disease during the follow-up and might require renal replacement therapies and/or kidney transplant [2, 3]. …”

Phenome-wide association study identifies marked increased in burden of comorbidities in African Americans with systemic lupus erythematosus

“…African Americans with SLE were three times more likely to have CAD compared to Caucasians with SLE. Administrative studies have shown increased CAD in African Americans compared to Caucasians with SLE when restricting analyses to inpatient encounters and subsets of patients with SLE [35, 36]. Our study builds upon these studies by including all patients with SLE and capturing CAD in both inpatient and outpatient encounters.…”

“…There are fewer studies comparing risk of these cardiovascular diseases in African Americans to Caucasians with SLE, with mixed results [36, 37]. Specifically, in one cohort, there were no differences in rates of CVD and PVD comparing African Americans to Caucasians [39].…”