Increased Risk of Death in Pediatric and Adult Patients with ESRD Secondary to Lupus

Overview

Journal Pediatr Nephrol

Specialties Nephrology
Pediatrics

Date 2010 Oct 5

PMID 20890767

Citations 23

Authors

Sangeeta Sule

Barbara Fivush

Alicia Neu

Susan Furth

Affiliations

Soon will be listed here.

Abstract

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that can cause significant kidney disease. Our goal was to assess the relative mortality risk associated with SLE in pediatric and adult populations with end-stage renal disease (ESRD) maintained on hemodialysis (HD). We performed Kaplan-Meier survival analysis from data collected by the United States Renal Data System (USRDS) in strata of pediatric and adult patients. This file includes data on all Medicare-reimbursed renal replacement patients. Cox proportional hazard models were used to assess mortality after adjusting for race and gender. Subjects were censored at transplantation or at end of follow-up. Pediatric patients with ESRD secondary to SLE had a 2-fold increased risk of death compared with other pediatric patients with ESRD (hazard ratio [HR]: 2.4, 95% confidence interval [CI]: 1.5-3.7). Adult patients with ESRD secondary to SLE were also at increased risk of death compared with other adult patients (HR: 1.7, 95% CI: 1.2-2.7). The most common causes of death in both pediatric and adult patients with SLE were cardiovascular disease and cardiac arrest. Our study demonstrates that there is a significant increase in mortality secondary to cardiovascular disease in pediatric and adult patients with ESRD secondary to SLE. Patients with ESRD secondary to SLE may need aggressive monitoring for traditional risk factors for atherosclerosis and the diagnosis of SLE alone may be an independent risk factor for death in patients with ESRD.

Citing Articles

Noninvasive biomarkers for lupus nephritis.

Liu T, Yang Y, Zhou Y, Jiang Y Lab Med. 2024; 55(5):535-542.

PMID: 38493322 PMC: 11371907. DOI: 10.1093/labmed/lmae015.

Efficacy and safety of multi-target therapy in children with lupus nephritis.

Zheng X, Ouyang X, Cheng C, Rong L, Chen L, Mo Y Pediatr Res. 2023; 94(6):2040-2046.

PMID: 37488301 DOI: 10.1038/s41390-023-02747-3.

How common is chronic kidney disease in children with lupus nephritis?.

Wenderfer S, Orjuela A, Dionne J Pediatr Nephrol. 2022; 38(6):1701-1705.

PMID: 36525081 DOI: 10.1007/s00467-022-05848-z.

Management and outcomes in children with lupus nephritis in the developing countries.

Khandelwal P, Govindarajan S, Bagga A Pediatr Nephrol. 2022; 38(4):987-1000.

PMID: 36255555 DOI: 10.1007/s00467-022-05769-x.

Cardiovascular disease in systemic lupus erythematosus.

McMahon M, Seto R, Skaggs B Rheumatol Immunol Res. 2022; 2(3):157-172.

PMID: 35880242 PMC: 9242526. DOI: 10.2478/rir-2021-0022.

References

Falaschi F, Ravelli A, Martignoni A, Migliavacca D, Sartori M, Pistorio A . Nephrotic-range proteinuria, the major risk factor for early atherosclerosis in juvenile-onset systemic lupus erythematosus. Arthritis Rheum. 2000; 43(6):1405-9. DOI: 10.1002/1529-0131(200006)43:6<1405::AID-ANR26>3.0.CO;2-V. View

Rood M, Ten Cate R, den Ouden E, Ouwerkerk F, Breedveld F, Huizinga T . Childhood-onset Systemic Lupus Erythematosus: clinical presentation and prognosis in 31 patients. Scand J Rheumatol. 1999; 28(4):222-6. DOI: 10.1080/03009749950155580. View

Wang T, Nam B, Wilson P, Wolf P, Levy D, Polak J . Association of C-reactive protein with carotid atherosclerosis in men and women: the Framingham Heart Study. Arterioscler Thromb Vasc Biol. 2002; 22(10):1662-7. DOI: 10.1161/01.atv.0000034543.78801.69. View

Jimenez S, Cervera R, Font J, Ingelmo M . The epidemiology of systemic lupus erythematosus. Clin Rev Allergy Immunol. 2003; 25(1):3-12. DOI: 10.1385/CRIAI:25:1:3. View

Parekh R, Plantinga L, Kao W, Meoni L, Jaar B, Fink N . The association of sudden cardiac death with inflammation and other traditional risk factors. Kidney Int. 2008; 74(10):1335-42. DOI: 10.1038/ki.2008.449. View

Esdaile J, Abrahamowicz M, Grodzicky T, Li Y, Panaritis C, du Berger R . Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. Arthritis Rheum. 2001; 44(10):2331-7. DOI: 10.1002/1529-0131(200110)44:10<2331::aid-art395>3.0.co;2-i. View

Bartosh S, Fine R, Sullivan E . Outcome after transplantation of young patients with systemic lupus erythematosus: a report of the North American pediatric renal transplant cooperative study. Transplantation. 2001; 72(5):973-8. DOI: 10.1097/00007890-200109150-00047. View

Frostegard J . Autoimmunity, oxidized LDL and cardiovascular disease. Autoimmun Rev. 2003; 1(4):233-7. DOI: 10.1016/s1568-9972(02)00059-9. View

Elliot V, Cairns T, Cook H . Evolution of lesions over 10 years in a patient with SLE: flowchart approach to the new International Society of Nephrology (ISN)/Renal Pathology Society (RPS) classification of lupus nephritis. Am J Kidney Dis. 2005; 47(1):184-90. DOI: 10.1053/j.ajkd.2005.06.027. View

10.

Weening J, DAgati V, Schwartz M, Seshan S, Alpers C, Appel G . The classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney Int. 2004; 65(2):521-30. DOI: 10.1111/j.1523-1755.2004.00443.x. View

11.

Parekh R, Zhang L, Fivush B, Klag M . Incidence of atherosclerosis by race in the dialysis morbidity and mortality study: a sample of the US ESRD population. J Am Soc Nephrol. 2005; 16(5):1420-6. DOI: 10.1681/ASN.2004080661. View

12.

Mangge H, Hubmann H, Pilz S, Schauenstein K, Renner W, Marz W . Beyond cholesterol--inflammatory cytokines, the key mediators in atherosclerosis. Clin Chem Lab Med. 2004; 42(5):467-74. DOI: 10.1515/CCLM.2004.081. View

13.

Asanuma Y, Oeser A, Shintani A, Turner E, Olsen N, Fazio S . Premature coronary-artery atherosclerosis in systemic lupus erythematosus. N Engl J Med. 2003; 349(25):2407-15. DOI: 10.1056/NEJMoa035611. View

14.

Van Doornum S, McColl G, Wicks I . Accelerated atherosclerosis: an extraarticular feature of rheumatoid arthritis?. Arthritis Rheum. 2002; 46(4):862-73. DOI: 10.1002/art.10089. View

15.

Petri M, Perez-Gutthann S, Spence D, Hochberg M . Risk factors for coronary artery disease in patients with systemic lupus erythematosus. Am J Med. 1992; 93(5):513-9. DOI: 10.1016/0002-9343(92)90578-y. View

16.

Fong K, Thumboo J, Koh E, Chng H, Leong K, Koh W . Systemic lupus erythematosus: initial manifestations and clinical features after 10 years of disease. Ann Acad Med Singap. 1997; 26(3):278-81. View

17.

Elliott J, Manzi S . Cardiovascular risk assessment and treatment in systemic lupus erythematosus. Best Pract Res Clin Rheumatol. 2009; 23(4):481-94. DOI: 10.1016/j.berh.2009.03.005. View

18.

Roman M, Shanker B, Davis A, Lockshin M, Sammaritano L, Simantov R . Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus. N Engl J Med. 2003; 349(25):2399-406. DOI: 10.1056/NEJMoa035471. View

19.

Manzi S, Selzer F, Sutton-Tyrrell K, Fitzgerald S, Rairie J, Tracy R . Prevalence and risk factors of carotid plaque in women with systemic lupus erythematosus. Arthritis Rheum. 1999; 42(1):51-60. DOI: 10.1002/1529-0131(199901)42:1<51::AID-ANR7>3.0.CO;2-D. View

20.

Ridker P, Rifai N, Pfeffer M, Sacks F, Lepage S, Braunwald E . Elevation of tumor necrosis factor-alpha and increased risk of recurrent coronary events after myocardial infarction. Circulation. 2000; 101(18):2149-53. DOI: 10.1161/01.cir.101.18.2149. View