New research found a significant increase in incidence rates of end-stage renal disease in the United States among patients ages 5 to 39 and among African Americans.
A second related study the largest pediatric lupus nephritis-associated ESRD study to date, according to the researchers revealed high rates of adverse outcomes among children with ESRD due to lupus nephritis. Despite novel therapies, outcomes have not improved in over a decade.
Both studies Trends in the Incidence, Demographics and Outcomes of End-Stage Renal Disease Due to Lupus Nephritis in the U.S., 1995-2006 and End-Stage Renal Disease due to Lupus Nephritis among Children in the U.S., 1995-2006 appear on the website of Arthritis & Rheumatism.
For the first study, a research team identified 12,344 cases of lupus nephritis ESRD with a mean age of onset of 41 years; 82% were female and 50% were African-American. During the study period, standardized incidence rates (SIRs) increased significantly among patients 5 to 39 years of age and African Americans, and in the Southeast. African Americans had a SIR of six to seven times that of white patients.
Researchers also noted that rates of pre-emptive kidney transplantation at ESRD onset slightly increased, but kidney transplantation rates within the first three years of ESRD declined. Rates of mortality did not change during more than a decade of evaluation.
In the study specifically examining outcomes among children with lupus nephritis-associated ESRD, there were 583 cases identified and the mean age of onset was 16.2 years. Of those children with ESRD, 51% were African-American, 39% were white, and 24% were Hispanic.
Researchers determined that within five years of ESRD onset, 49% of children were wait-listed for kidney transplant, 33% received a kidney transplant and 22% died. The primary causes of mortality among children with ESRD were cardiopulmonary complications (31%) and infections (16%); risk of mortality in African-American children was almost double that of white children.
Although advances in treatment, such as preemptive kidney transplantation at ESRD onset, have been made in recent years, researchers found no improvement in outcomes. The team reported higher incidence rates in younger patients (ages 5 to 19 and 20 to 39 years), among African Americans and in the South.
Age, race, ethnicity, insurance, and geographic region were associated with significant variations in five-year wait-listing for kidney transplant, kidney transplantation and mortality among children with ESRD.