ESRD from lupus nephritis in the United States, 1995–2010

Abstract

Background and objectives While ESRDfromlupus nephritis (ESLN) increased in theUnited States after themid-1990s and racial disparities were apparent, current trends are unknown. Design, setting, participants, &measurements Retrospective US Renal Data Systemdata (n=1,557,117) were used to calculate standardized incidence ratios (standardized to 1995–1996) and outcomes of ESLN (n=16,649). For events occurring after initiation of RRT, follow-up ended on June 30, 2011. Results Overall ESLN rates (95% confidence intervals [95% CIs]) in 1995–1996 were 3.1 (2.9 to 3.2) cases per million per year. Rates were higher for subgroups characterized by African-American race (11.1 [95% CI, 10.3 to 11.9]); other race (4.9 [95% CI, 4.0 to 5.8]); female sex (4.9 [95%CI, 4.6 to 5.2]); and ages 20–29 years (4.9 [95%CI, 4.4 to 5.4]), 30–44 years (4.6 [95% CI, 4.2 to 5.0]), and 45–64 years (4.0 [95% CI, 3.7 to 4.4]). Standardized incidence ratios for the overall population in subsequent biennia were 1.19 (1.14 to 1.24) in 1997–1998, 1.17 (1.12 to 1.22) in 1999–2000, 1.17 (1.12 to 1.22) in 2001–2002, 1.21 (1.16 to 1.26) in 2003–2004, 1.18 (1.13 to 1.23) in 2005–2006, 1.16 (1.11 to 1.21) in 2007–2008, and 1.05 (1.01 to 1.09) in 2009–2010, respectively. During a median (interquartile range) follow-up of 4.4 (6.3) years, 42.6% of patients with ESLN died, 45.3% were listed for renal transplant, and 28.7%underwent transplantation. Patientswith ESLNweremore likely thanmatched controls to be listed for and to undergo transplantation, and mortality rates were similar. Among patients with ESLN, African Americans were less likely to undergo transplantation (adjusted hazard ratio, 0.54 [0.51 to 0.58]) and more likely to die prematurely (adjusted hazard ratio, 1.23 [1.17 to 1.30]). Conclusions While ESLN appears to have stopped increasing in the last decade, racial disparities in outcomes persist.