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    Changes Seen in Incidence of ESRD From Lupus Nephritis

    Disparities observed in pediatric patients; incidence up in younger patients, African-Americans

    WEDNESDAY, March 30 (HealthDay News) -- For children with lupus nephritis (LN)-associated end-stage renal disease (ESRD), disparities in treatment and mortality exist by several demographic characteristics; also, incidence rates have increased in younger patients and in African-Americans since 1995, according to two articles published online March 28 in Arthritis & Rheumatism.

    Linda T. Hiraki, M.D., of the Harvard School of Public Health in Boston, and colleagues studied demographic and clinical characteristics, predictors of wait-listing, and causes of death in 583 children with LN-associated ESRD. They found that children in the Northeast and West, as compared with the South, were more than two times as likely to be wait-listed and more than 50 percent more likely to be transplanted. There were fewer kidney transplants in older children than younger children, in African-Americans than whites, in Hispanics than non-Hispanics, and in those with Medicaid versus those with private insurance. Mortality was almost double among African-American children compared with white children.

    Karen H. Costenbader, M.D., M.P.H., of Harvard Medical School in Boston, and colleagues assessed trends in sociodemographic and clinical characteristics in 12,344 patients with LN ESRD between 1995 and 2006. They found that standardized incidence rates (SIRs) increased significantly during that time for people aged 5 to 39 years, African-Americans, and people living in the southeastern United States. Mortality rates remained the same throughout the 12-year period. In addition, there was a small increase in preemptive kidney transplant at onset of ESRD, but transplant rates in the first three years of ESRD declined.

    "The characteristics of LN ESRD patients and their initial therapies have changed in recent years. While SIRs rose in younger patients, among African-Americans and in the South, outcomes did not improve in over a decade of evaluation," Costenbader and colleagues write.

    Abstract - Hiraki
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    Abstract - Costenbader
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