Among children and adolescents on dialysis, those with lupus nephritis (LN) have higher risks for hospitalization and transplantation delay compared with children who have non-lupus glomerular disease (NLGD), investigators report.
In the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) registry (1991-2018) of patients aged 6 to 20 years on maintenance dialysis, 231 had LN and 1726 had NLGD. The index dialysis modality was hemodialysis for 60% and peritoneal dialysis for 40%.
Compared with patients with NLGD, patients with LN were significantly more likely to be hospitalized within 6 months (49.2% vs 35.1%) and 12 months (63.3% vs 48.6%) of dialysis initiation, Heather Wasik, MD, MHS, of Upstate Medical University in Syracuse, New York, and colleagues reported in the American Journal of Kidney Diseases. The median hospital stay was significantly longer for patients with LN: 9.5 vs 7 days. The LN group had higher rates of hospitalization with infection (54.0% vs 51.3%), access complications (40.0% vs 34.5%), hypertension (33.0% vs 27.1%), and other cardiovascular disease (23.0% vs 14.0%). The presence of anemia was significantly associated with 4.4-fold increased odds of hospitalization in the first year.
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The probabilities of kidney transplantation within 1 year and 1-3 years were a significant 64% and 27% lower, respectively, for the LN than NLGD group, the investigators reported. Results were adjusted for age, race, sex, dialysis modality, hypertension, anemia, and dialysis era. In a multivariable Cox regression model, only non-White race was significantly associated with a 53% lower probability of timely kidney transplantation.
According to Dr Wasik’s team, “Children with LN who require dialysis are at high risk of adverse outcomes including hospitalization and delay in kidney transplantation. Further study must be done to identify risk factors for adverse outcomes and to assess targeted interventions to decrease morbidity and mortality in this vulnerable population.”
The registry contained limited or no information on disease activity, medication and dosing, and socioeconomic status, which limited conclusions.
Reference
Wasik H, Chadha V, Galbiati S, Warady B, Atkinson M. Dialysis outcomes for children with lupus nephritis compared to children with other forms of nephritis: a retrospective cohort study. Am J Kidney Dis. Published online August 27, 2021. doi:10.1053/j.ajkd.2021.07.013
