Dr. Winkelmayer has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Affymax, Astellas, Vifor Fresenius Renal Pharmaceuticals, GlaxoSmithKline, Sandoz, and (more than $10,000) Amgen.
Variation in initial kidney replacement therapy for end-stage renal disease due to lupus nephritis in the United States†
Article first published online: 29 NOV 2011
Copyright © 2011 by the American College of Rheumatology
Arthritis Care & Research
Volume 63, Issue 12, pages 1642–1653, December 2011
How to Cite
Devlin, A., Waikar, S. S., Solomon, D. H., Lu, B., Shaykevich, T., Alarcón, G. S., Winkelmayer, W. C. and Costenbader, K. H. (2011), Variation in initial kidney replacement therapy for end-stage renal disease due to lupus nephritis in the United States. Arthritis Care Res, 63: 1642–1653. doi: 10.1002/acr.20607
Data for these analyses were provided by the US Renal Data System (USRDS), but the analysis and conclusions are those of the authors and do not represent the USRDS or the National Institute of Diabetes and Digestive and Kidney Diseases, NIH.
- Issue published online: 29 NOV 2011
- Article first published online: 29 NOV 2011
- Accepted manuscript online: 4 NOV 2011 03:01PM EST
- Manuscript Accepted: 19 AUG 2011
- Manuscript Received: 17 FEB 2011
- NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases
- Office of Research on Women's Health. Grant Number: R01-AR-057327
Little is known about the patterns of use of initial kidney replacement therapies among patients with lupus nephritis (LN) end-stage renal disease (ESRD). We aimed to identify sociodemographic and clinical factors associated with variation in initial kidney replacement therapies among LN ESRD patients.
Patients with incident LN ESRD (1995–2006) were identified in the US Renal Data System. Age, sex, race, ethnicity, medical insurance, employment status, residential region, clinical factors, and comorbidities were considered as potential predictors of ESRD treatment choice, i.e., peritoneal dialysis (PD), hemodialysis (HD), or preemptive kidney transplantation in age-adjusted and multivariable-adjusted logistic regression analyses.
Of the 11,317 individuals with incident LN ESRD, 82.0% initiated HD, 12.2% initiated PD, and 2.8% underwent preemptive kidney transplantation. Receiving initial PD was significantly associated with earlier calendar year, female sex, higher albumin and hemoglobin levels, and lower serum creatinine levels. African Americans (versus whites), Medicaid beneficiaries and those with no health insurance (versus private insurance), and those unemployed (versus employed) had significantly reduced PD initiation. Comorbidities including congestive heart failure, peripheral vascular disease, and the inability to ambulate were also associated with decreased PD. Many sociodemographic and clinical factors favoring PD were associated with preemptive kidney transplant (versus dialysis) as well.
Few patients with LN ESRD receive initial PD or preemptive kidney transplantation. Race, ethnicity, employment, and medical insurance type are strongly associated with initial kidney replacement therapy choice. Future studies need to investigate the appropriateness of sociodemographic and clinical variation and the comparative effectiveness of kidney replacement therapies for LN ESRD.