Evolution of Lesions Over 10 Years in a Patient With SLE: Flowchart Approach to the New International Society of Nephrology (ISN)/Renal Pathology Society (RPS) Classification of Lupus Nephritis

Increased risk of death in African American patients with end-stage renal disease secondary to lupus

Background

Systemic lupus erythematosus (SLE) is a devastating systemic disease that can lead to end-stage renal disease (ESRD). Our goal was to assess the relative mortality risk associated with race in pediatric and adult populations with ESRD secondary to SLE maintained on hemodialysis (HD).

Methods

We identified an inception cohort of patients who were started on HD in January 1990 from data collected by the United States Renal Data System (USRDS). Kaplan–Meier survival analyses were performed in these patients using the time at risk from 1 January 1990 through 31 December 2010, the last date of the USRDS data collection period in this dataset. Cox proportional hazard models were used to assess mortality, adjusted for age at dialysis initiation. Subjects were censored at transplantation or end of follow-up.

Results

There were 1580 patients with ESRD secondary to SLE, 252 pediatric patients (62% African American) and 1328 adults (56% African American). African American pediatric patients with ESRD secondary to SLE had a 2-fold increased risk of death compared with African American children with other causes of ESRD [hazard ratio (HR): 2.1, 95% confidence interval (CI): 1.4–2.9, P < 0.01]. Increased risk of death was also seen in African American adults with ESRD secondary to SLE compared with both Caucasians with ESRD secondary to SLE (HR: 2.3, 95% CI: 1.2–4.2, P < 0.01) and African American adults with ESRD secondary to other diseases (HR: 1.2, 95% CI: 1.1–1.4, P < 0.01).

Conclusion

Our study suggests that there is a significant increased risk for mortality in African American children and adults with ESRD secondary to SLE. This suggests that African Americans with ESRD secondary to SLE need aggressive monitoring.

Increased risk of death in pediatric and adult patients with ESRD secondary to lupus

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that can cause significant kidney disease. Our goal was to assess the relative mortality risk associated with SLE in pediatric and adult populations with end-stage renal disease (ESRD) maintained on hemodialysis (HD). We performed Kaplan-Meier survival analysis from data collected by the United States Renal Data System (USRDS) in strata of pediatric and adult patients. This file includes data on all Medicare-reimbursed renal replacement patients. Cox proportional hazard models were used to assess mortality after adjusting for race and gender. Subjects were censored at transplantation or at end of follow-up. Pediatric patients with ESRD secondary to SLE had a 2-fold increased risk of death compared with other pediatric patients with ESRD (hazard ratio [HR]: 2.4, 95% confidence interval [CI]: 1.5-3.7). Adult patients with ESRD secondary to SLE were also at increased risk of death compared with other adult patients (HR: 1.7, 95% CI: 1.2-2.7). The most common causes of death in both pediatric and adult patients with SLE were cardiovascular disease and cardiac arrest. Our study demonstrates that there is a significant increase in mortality secondary to cardiovascular disease in pediatric and adult patients with ESRD secondary to SLE. Patients with ESRD secondary to SLE may need aggressive monitoring for traditional risk factors for atherosclerosis and the diagnosis of SLE alone may be an independent risk factor for death in patients with ESRD.

Reduced albumin levels and utilization of arteriovenous access in pediatric patients with systemic lupus erythematosus (SLE)

Systemic lupus erythematosus (SLE) is an autoimmune disease that affects between five and ten thousand children in the USA. Kidney disease may progress to end-stage renal disease (ESRD) and subsequent need for dialysis therapy in a significant number of children with SLE. We performed a cross-sectional analysis comparing achievement of National Kidney Foundation/Kidney Disease Outcomes Quality Initiative clinical targets in pediatric patients with SLE maintained on hemodialysis (HD) to pediatric patients with other causes of ESRD. Ninety-seven unique SLE patients and two control groups-1,823 unique pediatric patients with other causes of ESRD and 694 pediatric patients with glomerulonephritis-were identified in the End Stage Renal Disease Clinical Performance Measures 2000-2004 Project Years. SLE patients were older, with a female and black race predominance compared with both control groups. Pediatric patients maintained on HD secondary to SLE were less likely to meet albumin targets and more likely to have vascular catheters than were pediatric patients on HD secondary to other causes. These findings may be associated with increased morbidity and mortality in pediatric patients with SLE maintained on HD and deserve further study.