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

Abstract

OBJECTIVE:

To identify predictors of wait-listing for kidney transplantation, kidney transplantation, and mortality among children with lupus nephritis-associated end-stage renal disease (ESRD).

METHODS:

Children ages 5-18 years with new-onset lupus nephritis-associated ESRD were identified in the US Renal Data System (1995-2006). Demographic and clinical characteristics, causes of death, and predictors of wait-listing for kidney transplantation, kidney transplantation, and mortality during the first 5 years of ESRD were investigated. Cox proportional hazards models were used.

RESULTS:

A total of 583 children had incident lupus nephritis-associated ESRD. The mean ± SD age of the patients at the time of ESRD onset was 16.2 ± 2.4 years; 49% were African American, and 24% were Hispanic. During the 5-year period after the onset of ESRD, 292 (49%) were wait-listed, 193 (33%) received a kidney transplant, and 131 (22%) died. The main causes of death were cardiopulmonary (31%) and infectious (16%). Children living in the northeast and west were more than twice as likely as children in the south to be wait-listed and were >50% more likely than children in the south to undergo transplantation. There were fewer kidney transplants among older versus younger patients (odds ratio [OR] 0.59, P = 0.009), African American versus white patients (OR 0.48, P < 0.001), Hispanic versus non-Hispanic patients (OR 0.63, P = 0.03), and those with Medicaid versus those with private insurance (OR 0.70, P = 0.03). Mortality among African American children was almost double that among white children (OR 1.83, P < 0.001).

CONCLUSION:

Among US children with lupus nephritis-associated ESRD, age, race, ethnicity, type of medical insurance, and geographic region were associated with significant variation in 5-year wait-listing for kidney transplantation, kidney transplantation, and mortality.

• Authors: Linda T Hiraki, Bing Lu, Steven R Alexander, Tamara Shaykevich, Graciela S Alarcón, Daniel H Solomon, Wolfgang C Winkelmayer, Karen H Costenbader
• Journal: Arthritis and rheumatism (Arthritis Rheum) Vol. 63 Issue 7 Pg. 1988-97 (Jul 2011) ISSN: 1529-0131 [Electronic] United States
• PMID: 21445963 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)
• Copyright: Copyright © 2011 by the American College of Rheumatology.

Topics

• Adolescent
• Black or African American
• Age of Onset
• Child
• Child, Preschool
• Female
• Health Services Accessibility
• Healthcare Disparities
• Humans
• Incidence
• Kidney (surgery)
• Kidney Failure, Chronic (epidemiology, etiology, mortality, surgery)
• Kidney Transplantation
• Lupus Nephritis (complications, mortality, surgery)
• Male
• Odds Ratio
• Risk Factors
• United States