Original InvestigationPathogenesis and Treatment of Kidney DiseaseSurvival Disparity of African American Versus Non–African American Patients With ESRD Due to SLE
Section snippets
Methods
This study used the US Renal Data System (USRDS) database, which incorporates baseline and follow-up demographic and clinical data for all patients accessing the Medicare ESRD program in the United States. We conducted a retrospective cohort study consisting of patients who initiated maintenance dialysis therapy from January 1, 1995, through December 31, 2006, and were followed up until December 31, 2010. Our cohort consisted only of patients who were included in the USRDS annual data reports
Results
We identified 12,352 patients with LN-caused ESRD in a retrospective cohort of 1,132,202 patients who initiated maintenance dialysis therapy from January 1, 1995, through December 31, 2006, followed up until December 31, 2010. Table 1 shows demographic and unadjusted characteristics of the LN-caused versus other-cause ESRD cohort. Compared to the general ESRD population, patients with LN-caused ESRD were more likely to be younger at dialysis therapy initiation, African American, women, and on
Discussion
It is widely reported that among patients with ESRD on maintenance dialysis therapy, African Americans have lower mortality than non–African Americans, especially in comparison with white patients.11 Our findings indicate that among patients with ESRD due to LN, African Americans have higher mortality compared with non–African Americans (adjusted HR, 1.18). This survival disadvantage among African American patients with LN-caused ESRD was significantly attenuated by area-level median household
Acknowledgements
The views expressed in this aticle are those of the authors and do not reflect the official policy of the Department of the Army, the Department of the Navy, the Department of Defense, or the United States government.
Support: None.
Financial Disclosure: The authors declare that they have no relevant financial interests.
Contributions: Research idea and study design: RN, KCA, JMO, DJL; data acquisition: LA, KCA; data analysis/interpretation: RN, KCA, CMY, LA, MAW; statistical analysis: RN, KCA;
References (28)
- et al.
Time-dependent bias was common in survival analyses published in leading clinical journals
J Clin Epidemiol
(2004) - et al.
Delayed referral of black, Hispanic, and older patients with chronic renal failure
Am J Kidney Dis
(1999) - et al.
Disparities in provision of transplant information affect access to kidney transplantation
Am J Transplant
(2012) - et al.
Disparities in provision of transplant education by profit status of the dialysis center
Am J Transplant
(2012) Lupus nephritis
J Am Soc Nephrol
(1999)- et al.
An assessment of renal failure in an SLE cohort with special reference to ethnicity, over a 25-year period
Rheumatology (Oxford)
(2006) - et al.
Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients
Medicine (Baltimore)
(2003) - et al.
Variation in initial kidney replacement therapy for end-stage renal disease due to lupus nephritis in the United States
Arthritis Care Res (Hoboken)
(2011) - et al.
Increased hospitalizations and death in patients with ESRD secondary to lupus
Lupus
(2012) - et al.
Increased risk of death in pediatric and adult patients with ESRD secondary to lupus
Pediatr Nephrol
(2011)
Increased risk of death in African American patients with ESRD secondary to lupus
Clin Kidney J
High-risk features of lupus nephritis: importance of race and clinical and histological factors in 166 patients
Nephrol Dial Transplant
Severe lupus nephritis: racial differences in presentation and outcome
J Am Soc Nephrol
Influence of race/ethnicity on response to lupus nephritis treatment: the ALMS study
Rheumatology (Oxford)
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