American journal of kidney diseases : the official journal of the National Kidney Foundation | 2021
Dialysis Outcomes for Children With Lupus Nephritis Compared to Children With Other Forms of Nephritis: A Retrospective Cohort Study.
Abstract
RATIONALE & OBJECTIVE\nChildren with lupus nephritis (LN) are at high risk of developing end-stage kidney disease (ESKD) requiring dialysis initiation. This study aimed to compare outcomes among children on dialysis with LN to those with non-lupus glomerular disease (NLGD) and to investigate risk factors for adverse outcomes among children with LN on dialysis.\n\n\nSTUDY DESIGN\nRetrospective cohort study.\n\n\nSETTING & PARTICIPANTS\nChildren and adolescents age 6-20 years with LN (N=231) and NLGD (N=1,726) who initiated maintenance dialysis 1991-2018 and enrolled in the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) registry.\n\n\nEXPOSURE\nLupus nephritis.\n\n\nOUTCOMES\nHospitalization, mortality, time to transplant.\n\n\nANALYTICAL APPROACH\nContingency tables to compare hospitalizations and multivariable cause-specific hazards models to compare rates of death and transplantation in children with LN compared to those with NLGD. Using data from children with LN, multivariable logistic regression models were fit to evaluate risk factors for hospitalization and multivariable Cox regression models were fit to evaluate factors associated with kidney transplantation.\n\n\nRESULTS\nChildren with LN were more likely to be hospitalized in the first year following dialysis initiation (63.3% vs 48.6%, p<0.001) and were less likely to receive a kidney transplant in the first 3 years following dialysis initiation (year 0-1: 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 following dialysis initiation (aOR 4.44, 95% CI 1.44-13.66, p=0.01). Nonwhite race was associated with a lower rate of kidney transplantation (aHR p=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).\n\n\nLIMITATIONS\nThe NAPRTCS registry does not collect information on lupus disease activity or medication doses and has limited data on medication use.\n\n\nCONCLUSIONS\nChildren and adolescents with LN on dialysis are at higher risk for adverse outcomes including hospitalization and lower rates of kidney transplantation compared to children with NLGD receiving maintenance dialysis.