Rates of end-stage renal disease (ESRD) from lupus nephritis in the United States have stopped increasing and may be declining, but racial disparities in outcomes persist, according to researchers.
In a retrospective study using the U.S. Renal Data System database, investigators at the Chronic Disease Research Group of the Minneapolis Medical Research Foundation in Minneapolis, analyzed data from 1,557,117 individuals who initiated renal replacement therapy (RRT) from 1995–2010. Of these, 16,649 had ESRD from systemic lupus erythematosus (SLE).
The researchers, led by Robert N. Foley, MD, calculated standardized incidence ratios (SIRs) to 1995–1996, when the rate of SLE-related ESRD was 3.2 cases per million per year. Rates per million during 1995–1996 were higher for African Americans (11.1), female subjects (4.9), and individuals aged 20–29 (4.9), 30–44 (4.6), and 45–64 (4.0).
For the overall population, the SIRs of SLE-related ESRD requiring RRT were 1.19 in 1997–1998, 1.17 in 1999–2000, 1.17 in 2001–2002, 1.21 in 2003–2004, 1.18 in 2005–2006, 1.16 in 2007–2008, and 1.05 in 2009–2010, according to findings published online ahead of print in the Clinical Journal of the American Society of Nephrology.
During a median follow-up of 4.4 years, 42.6% of individuals with ESRD from SLE died, 45.3% were listed for renal transplantation, and 28.7% underwent transplantation.
Compared with white patients, African-American patients were 23% more likely to die, after adjusting for age, sex, and other variables. Although African-American patients were 11% more likely that white patients to be listed for a renal transplant, they were 46% less likely to receive one.
The SLE patients were matched to a control group of patients who initiated RRT for ESRD not due to SLE. These controls were matched to SLE patients according to year of RRT initiation, sex, age, race, and ethnicity. Compared with controls, the SLE patients were more likely to be listed for a renal transplant, more likely to undergo transplantation, and just as likely to die, the researchers reported.