Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Outcomes of End-Stage Renal Disease Due to Lupus Nephritis among Children in the U.S., 19952006.

Hiraki6,  Linda T., Lu3,  Bing, Brookhart8,  M. Alan, Shaykevich4,  Tamara, Alarcon1,  Graciela S., Solomon5,  Daniel Hal, Winkelmayer7,  Wolfgang

Oakland, CA
Brigham & Women, Boston, MA
Brigham and Women's Hospital, Foxboro, MA
Brigham and Women's Hospital
Brigham and Womens Hospital, Boston, MA
Harvard School of Public Health, Boston, MA
Stanford University School of Medicine
University of North Carolina, Chapel Hill

Purpose:

Little information is available on kidney transplantation and overall survival among children with end-stage renal disease (ESRD) due to lupus nephritis in the U.S. We examined rates and predictors of kidney transplantation and overall survival among children with ESRD due to lupus nephritis from 1995–2006.

Methods:

We identified children ages 5–19 years with new onset ESRD due to lupus nephritis from 1995–2006, as defined by Medicare eligibility and entry into the U.S. Renal Data System, which includes data on approximately 94% of all U.S. ESRD patients. Lupus was identified as the cause of ESRD on medical evidence forms. We investigated baseline demographic and clinical characteristics of patients at ESRD onset, rates of kidney transplantation and overall survival, and causes of death. Predictors of these outcomes in the first five years of ESRD were identified using Cox proportional hazards models, adjusting for sociodemographic and clinical factors.

Results:

We identified 583 children in the U.S. who had incident ESRD due to lupus nephritis. Mean age at ESRD onset was 16.2 (SD 2.4) years. Sex, race, ethnicity, region of residence and medical insurance type at ESRD are shown in Table 1. Within 5 years after onset of ESRD, 193 (33% overall) received a kidney transplantation and 131 (22%) died. Mean age at kidney transplantation was 18.2 (SD 3.4) years and at death was 19.5 (SD 3.5) years. Causes of death were cardiorespiratory (39%), infectious (19%), hemorrhagic (10%), neurologic (9%) and other (19%). In multivariable models, residence in the U.S. Northeast, compared to the South, was associated with increased rates of kidney transplantation. Five year rates of both kidney transplantation and overall survival were less than half among Black compared to white children. Sex, ethnicity, medical insurance and clinical factors were not independent predictors of outcomes in these children.

Table 1. Multivariable-adjusted* Five Year Hazard Ratios (HRs) according to Sociodemographic Factors for Children ages 5–19 years with End-Stage Renal Disease (ESRD) due to Lupus Nephritis in the U.S., 1995–2006

Sociodemographic factor (n)Renal Transplantation** (95% CI***)Survival** (95% CI***)
Sex  
        Female (442)1.0 (ref.)1.0 (ref.)
        Male (141)0.99 (0.68, 1.43)0.68 (0.45, 1.03)
Race  
        White (219)1.0 (ref.)1.0 (ref.)
        Black (287)0.48 (0.32, 0.71)0.44 (0.24, 0.80)
        Asian (46)0.85 (0.49, 1.48)1.01 (0.36, 2.86)
        Other (14)0.66 (0.20, 2.17)0.39 (0.13, 1.2)
Ethnicity  
        Non-Hispanic (441)1.0 (ref.)1.0 (ref.)
        Hispanic (142)0.65 (0.41, 1.01)1.1 (0.55, 2.22)
Region  
        South (247)1.0 (ref.)1.0 (ref.)
        Northeast (82)1.84 (1.21, 2.80)1.56 (0.53, 2.94)
        MidWest (97)1.04 (0.66, 1.64)1.56 (0.9, 2.78)
        West (146)1.2 (0.80, 1.81)1.12 (0.66, 1.92)
Medical Insurance  
        Private (224)1.0 (ref.)1.0 (ref.)
        Medicaid (285)0.79 (0.57, 1.09)1.01 (0.66, 1.52)
        None (52)0.71 (0.38, 1.32)0.78 (0.41, 1.45)
        Other (14)1.33 (0.47, 3.75)0.78 (0.18, 3.33)
*Multivariable model: Age, sex, race, ethnicity, medical insurance, region, diabetes mellitus, hypertension, erythropoietin use, body mass index (kg/m2), and initial ESRD therapy (hemodialysis, peritoneal dialysis or pre-emptive transplant)
**Renal transplantation among all incident dialysis patients (n = 579) and survival among all incident ESRD patients (including pre-emptively transplanted, n = 583)
***95% Confidence Interval by Wald method

Conclusions:

Among children with ESRD due to lupus nephritis in the U.S., geographic region and race were the most important predictors of five year kidney transplantation and survival rates. Although these analyses do not account for WHO class of nephritis or lupus disease activity, the results suggest that important disparities in access to care and outcomes exist by region and race in the U.S.

To cite this abstract, please use the following information:
Hiraki, Linda T., Lu, Bing, Brookhart, M. Alan, Shaykevich, Tamara, Alarcon, Graciela S., Solomon, Daniel Hal, et al; Outcomes of End-Stage Renal Disease Due to Lupus Nephritis among Children in the U.S., 19952006. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2104
DOI: 10.1002/art.29869

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