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Dialysis Outcomes for Children With Lupus Nephritis Compared to Children With Other Forms of Nephritis: A
Heather Wasik1, Vimal Chadha2, Shirley Galbiati3
1Division of Pediatric Nephrology, SUNY Upstate Medical University, Syracuse, New York.
Insights
Children with lupus nephritis (LN) on dialysis face higher hospitalization rates and reduced kidney transplant likelihood compared to peers with other kidney diseases. Anemia and non-White race are linked to worse outcomes in pediatric LN patients.
Area of Science:
- Pediatric Nephrology
- Autoimmune Diseases
- Renal Replacement Therapy
Background:
- Children with lupus nephritis (LN) have a high risk of kidney failure.
- Kidney replacement therapy (dialysis or transplant) is often necessary for these children.
- Outcomes for pediatric LN patients on dialysis require further investigation.
Purpose of the Study:
- To compare outcomes of children with LN on dialysis versus those with non-lupus glomerular disease.
- To identify risk factors for adverse outcomes in pediatric LN patients undergoing dialysis.
Main Methods:
- Retrospective cohort study utilizing the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) registry.
- Included children and adolescents (6-20 years) initiating maintenance dialysis between 1991-2018.
- Compared hospitalization, mortality, and transplant rates using statistical models; analyzed risk factors for adverse events in LN patients.
Main Results:
- Children with LN had higher first-year hospitalization rates (63.3% vs. 48.6%) and lower kidney transplant rates within 3 years compared to controls.
- Anemia was a significant risk factor for hospitalization (OR, 4.44).
- Non-White race was associated with reduced kidney transplant rates (AHR, 0.47); LN was not linked to increased mortality on dialysis.
Conclusions:
- Pediatric patients with LN on dialysis experience worse outcomes, including increased hospitalizations and fewer transplants, than those with other glomerular diseases.
- Anemia and non-White race are identified as risk factors for adverse outcomes in this vulnerable population.
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.
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