Dr. Brookhart has received research grants and contracts from Amgen.
Systemic Lupus Erythematosus
Trends in the incidence, demographics, and outcomes of end-stage renal disease due to lupus nephritis in the US from 1995 to 2006†
Version of Record online: 31 MAY 2011
Copyright © 2011 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 63, Issue 6, pages 1681–1688, June 2011
How to Cite
Costenbader, K. H., Desai, A., Alarcón, G. S., Hiraki, L. T., Shaykevich, T., Brookhart, M. A., Massarotti, E., Lu, B., Solomon, D. H. and Winkelmayer, W. C. (2011), Trends in the incidence, demographics, and outcomes of end-stage renal disease due to lupus nephritis in the US from 1995 to 2006. Arthritis & Rheumatism, 63: 1681–1688. doi: 10.1002/art.30293
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 USRDS or the National Institute of Diabetes and Digestive and Kidney Diseases, NIH.
- Issue online: 31 MAY 2011
- Version of Record online: 31 MAY 2011
- Accepted manuscript online: 28 MAR 2011 12:18PM EST
- Manuscript Accepted: 3 FEB 2011
- Manuscript Received: 19 NOV 2010
- NIH (National Institute of Arthritis and Musculoskeletal and Skin Diseases)
- Office of Research on Women's Health. Grant Number: R01-AR-057327
- National Institute on Aging Career Development award. Grant Number: AG-027400
- NIH. Grant Number: K24-AR-055989
This study was undertaken to investigate whether recent advances in lupus nephritis treatment have led to changes in the incidence of end-stage renal disease (ESRD) secondary to lupus nephritis, or in the characteristics, treatments, and outcomes of patients with lupus nephritis ESRD.
Patients with incident lupus nephritis ESRD (1995–2006) were identified in the US Renal Data System. Trends in sociodemographic and clinical characteristics were assessed. We tested for temporal changes in standardized incidence rates (SIRs) for sociodemographic groups using Poisson regression. Changes in rates of waitlisting for kidney transplant, kidney transplantation, and all-cause mortality were examined using crude and adjusted time-to-event analyses.
We identified 12,344 incident cases of lupus nephritis ESRD. Mean age at ESRD onset was 41 years; 81.6% of the patients were women and 49.5% were African American. SIRs for lupus nephritis ESRD among those who were ages 5–39 years, African American, or lived in the southeastern US increased significantly from 1995 to 2006. Increases in body mass index and in the prevalence of both diabetes mellitus and hypertension were detected. Mean serum hemoglobin level at ESRD onset increased, while that of serum creatinine decreased over time. More patients received hemodialysis and fewer received peritoneal dialysis. There was a slight increase in the frequency of preemptive kidney transplantation at ESRD onset, but kidney transplantation rates within the first 3 years of ESRD declined. Mortality did not change over the 12 years of study.
Our findings indicate that the characteristics of patients with lupus nephritis ESRD and initial therapies have changed in recent years. While SIRs rose in younger patients, among African Americans, and in the South, outcomes did not improve in over a decade of evaluation.