TY - JOUR
T1 - Dialysis Outcomes for Children With Lupus Nephritis Compared to Children With Other Forms of Nephritis
T2 - A Retrospective Cohort Study
AU - Wasik, Heather
AU - Chadha, Vimal
AU - Galbiati, Shirley
AU - Warady, Bradley
AU - Atkinson, Meredith
N1 - Funding Information:
Heather Wasik, MD, MHS, Vimal Chadha, MD, Shirley Galbiati, MS, Bradley Warady, MD, and Meredith Atkinson, MD, MHS. Research idea and study design: HW, VC, BW, MA; data analysis/interpretation: HW, VC, SG, BW, MA; statistical analysis: SG; supervision or mentorship: BW, MA. Each author contributed important intellectual content during manuscript drafting or revision and agrees to be personally accountable for the individual's own contributions and to ensure that questions pertaining to the accuracy or integrity of any portion of the work, even one in which the author was not directly involved, are appropriately investigated and resolved, including with documentation in the literature if appropriate. Statistical analysis for this study was provided by the Emmes Company, LLC, with funding from a NAPRTCS special studies award. No additional funding supported this work. The authors declare that they have no relevant financial interests. Aspects of this work were accepted for presentation at the North American Pediatric Renal Trials and Collaborative Studies 2019 Meeting (St. Louis, MO, September 2019), the 2020 World Congress of Nephrology (Abu Dhabi, United Arab Emirates, March 2020; not presented due to pandemic), Pediatric Academic Societies 2020 Meeting (Philadelphia, PA, May 2020; not presented due to pandemic), and 2021 Annual Dialysis Conference (virtual, March 2021). Received January 19, 2021. Evaluated by 3 external peer reviewers, with direct editorial input from a Statistics/Methods Editor, an Associate Editor, and the Editor-in-Chief. Accepted in revised form Accepted July 16, 2021.
Publisher Copyright:
© 2021 National Kidney Foundation, Inc.
PY - 2022/5
Y1 - 2022/5
N2 - Rationale & Objective: Children with lupus nephritis (LN) are at high risk of developing kidney failure requiring initiation of kidney replacement therapy. This study compared outcomes among children with LN on dialysis with children with non-lupus glomerular disease and investigated risk factors for adverse outcomes among children with LN on dialysis. Study Design: Retrospective cohort study. Setting & Participants: Children and adolescents aged 6-20 years with LN (n = 231) and non-lupus glomerular disease (n = 1,726) who initiated maintenance dialysis 1991-2018 and were enrolled in the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) registry. Exposure: Lupus nephritis. Outcome: Hospitalization, mortality, and time to transplant. Analytical Approach: Contingency tables were used to compare hospitalizations, and multivariable cause-specific hazards models were used to compare rates of death and transplantation in children with LN compared with those with non-lupus glomerular disease. Using data from children with LN, multivariable logistic regression models were fit to evaluate the risk factors for hospitalization, and multivariable Cox regression models were fit to evaluate factors associated with kidney transplantation. Results: Children with LN were more likely to be hospitalized in the first year after dialysis initiation (63.3% vs 48.6%, P < 0.001) and were less likely to receive a kidney transplant in the first 3 years after dialysis initiation (year 0-1: adjusted hazard ratio [AHR], 0.36 [95% CI, 0.23-0.57], P < 0.001; year 1-3: AHR, 0.73 [95% CI, 0.54-0.98], P = 0.04). Anemia was associated with hospitalization after dialysis initiation (adjusted OR, 4.44 [95% CI, 1.44-13.66], P = 0.01). Non-White race was associated with a lower rate of kidney transplantation (AHR, 0.47 [95% CI, 0.27-0.82], P = 0.01). LN was not associated with death while on dialysis (AHR, 1.21 [95% CI, 0.47-3.11], P = 0.7). Limitations: The NAPRTCS registry does not collect information on lupus disease activity or medication doses and has limited data on medication use. Conclusions: Children and adolescents with LN on dialysis are at higher risk for adverse outcomes including hospitalization and lower rates of kidney transplantation compared with children with non-lupus glomerular disease receiving maintenance dialysis.
AB - Rationale & Objective: Children with lupus nephritis (LN) are at high risk of developing kidney failure requiring initiation of kidney replacement therapy. This study compared outcomes among children with LN on dialysis with children with non-lupus glomerular disease and investigated risk factors for adverse outcomes among children with LN on dialysis. Study Design: Retrospective cohort study. Setting & Participants: Children and adolescents aged 6-20 years with LN (n = 231) and non-lupus glomerular disease (n = 1,726) who initiated maintenance dialysis 1991-2018 and were enrolled in the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) registry. Exposure: Lupus nephritis. Outcome: Hospitalization, mortality, and time to transplant. Analytical Approach: Contingency tables were used to compare hospitalizations, and multivariable cause-specific hazards models were used to compare rates of death and transplantation in children with LN compared with those with non-lupus glomerular disease. Using data from children with LN, multivariable logistic regression models were fit to evaluate the risk factors for hospitalization, and multivariable Cox regression models were fit to evaluate factors associated with kidney transplantation. Results: Children with LN were more likely to be hospitalized in the first year after dialysis initiation (63.3% vs 48.6%, P < 0.001) and were less likely to receive a kidney transplant in the first 3 years after dialysis initiation (year 0-1: adjusted hazard ratio [AHR], 0.36 [95% CI, 0.23-0.57], P < 0.001; year 1-3: AHR, 0.73 [95% CI, 0.54-0.98], P = 0.04). Anemia was associated with hospitalization after dialysis initiation (adjusted OR, 4.44 [95% CI, 1.44-13.66], P = 0.01). Non-White race was associated with a lower rate of kidney transplantation (AHR, 0.47 [95% CI, 0.27-0.82], P = 0.01). LN was not associated with death while on dialysis (AHR, 1.21 [95% CI, 0.47-3.11], P = 0.7). Limitations: The NAPRTCS registry does not collect information on lupus disease activity or medication doses and has limited data on medication use. Conclusions: Children and adolescents with LN on dialysis are at higher risk for adverse outcomes including hospitalization and lower rates of kidney transplantation compared with children with non-lupus glomerular disease receiving maintenance dialysis.
KW - Children
KW - dialysis
KW - end-stage kidney disease (ESKD)
KW - glomerular disease
KW - lupus nephritis (LN)
KW - mortality
KW - pediatric
KW - registry
KW - renal replacement therapy (RRT)
KW - systemic lupus erythematosus (SLE)
UR - http://www.scopus.com/inward/record.url?scp=85119069134&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85119069134&partnerID=8YFLogxK
U2 - 10.1053/j.ajkd.2021.07.013
DO - 10.1053/j.ajkd.2021.07.013
M3 - Article
C2 - 34461164
AN - SCOPUS:85119069134
SN - 0272-6386
VL - 79
SP - 626
EP - 634
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 5
ER -