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.

中文翻译：

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狼疮性肾炎儿童与其他形式肾炎儿童相比的透析结果：一项回顾性队列研究

基本原理和目标

患有狼疮性肾炎 (LN) 的儿童发生肾衰竭的风险很高，需要开始肾脏替代治疗。本研究比较了 LN 儿童透析与非狼疮性肾小球疾病儿童的结局，并调查了 LN 透析儿童不良结局的危险因素。

学习规划

回顾性队列研究。

设置与参与者

1991-2018 年开始维持性透析并参加北美儿科肾脏试验和协作研究 (NAPRTCS) 登记的 6-20 岁患有 LN (n = 231) 和非狼疮性肾小球疾病 (n = 1,726) 的儿童和青少年.

暴露

狼疮性肾炎。

结果

住院、死亡率和移植时间。

分析方法

列联表用于比较住院情况，并使用多变量原因特定风险模型来比较 LN 患儿与非狼疮性肾小球疾病患儿的死亡率和移植率。使用来自患有 LN 的儿童的数据，多变量逻辑回归模型适合评估住院的危险因素，多变量 Cox 回归模型适合评估与肾移植相关的因素。

结果

患有 LN 的儿童在透析开始后的第一年更有可能住院（63.3% vs 48.6%，P  < 0.001），并且在透析开始后的前 3 年接受肾移植的可能性较小（0-1 年：调整后的风险比 [AHR]，0.36 [95% CI，0.23-0.57]，P  < 0.001；第 1-3 年：AHR，0.73 [95% CI，0.54-0.98]，P  = 0.04）。贫血与透析开始后的住院有关（调整后的 OR，4.44 [95% CI，1.44-13.66]，P  = 0.01）。非白人种族与较低的肾移植率相关（AHR，0.47 [95% CI，0.27-0.82]，P  = 0.01）。LN 与透析期间的死亡无关（AHR，1.21 [95% CI，0.47-3.11]，P  = 0.7）。

限制

NAPRTCS 登记处不收集有关狼疮疾病活动或药物剂量的信息，并且药物使用的数据有限。

结论

与接受维持性透析的非狼疮性肾小球疾病儿童相比，接受透析的 LN 儿童和青少年发生不良后果的风险更高，包括住院和肾移植率更低。