Dr. Solomon has received research grants from Abbott and Amgen and conference support from Bristol-Myers Squibb.
End-stage renal disease due to lupus nephritis among children in the US, 1995–2006†
Article first published online: 29 JUN 2011
Copyright © 2011 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 63, Issue 7, pages 1988–1997, July 2011
How to Cite
Hiraki, L. T., Lu, B., Alexander, S. R., Shaykevich, T., Alarcón, G. S., Solomon, D. H., Winkelmayer, W. C. and Costenbader, K. H. (2011), End-stage renal disease due to lupus nephritis among children in the US, 1995–2006. Arthritis & Rheumatism, 63: 1988–1997. doi: 10.1002/art.30350
Data for this analysis were provided by the United States 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 published online: 29 JUN 2011
- Article first published online: 29 JUN 2011
- Accepted manuscript online: 28 MAR 2011 12:18PM EST
- Manuscript Accepted: 8 MAR 2011
- Manuscript Received: 22 SEP 2010
- NIH. Grant Number: K24-AR-55989
- National Institute of Arthritis
- Musculoskeletal and Skin Diseases
- Office of Research on Women's Health. Grant Number: R01-AR-057327
- Canadian Institute of Health Research Health Professionals Fellowship award
To identify predictors of wait-listing for kidney transplantation, kidney transplantation, and mortality among children with lupus nephritis–associated end-stage renal disease (ESRD).
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.
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).
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.