Variation in initial kidney replacement therapy for end-stage renal disease due to lupus nephritis in the United States

Arthritis Care Res (Hoboken). 2011 Dec;63(12):1642-53. doi: 10.1002/acr.20607.


Objective: Little is known about the patterns of use of initial kidney replacement therapies among patients with lupus nephritis (LN) end-stage renal disease (ESRD). We aimed to identify sociodemographic and clinical factors associated with variation in initial kidney replacement therapies among LN ESRD patients.

Methods: Patients with incident LN ESRD (1995-2006) were identified in the US Renal Data System. Age, sex, race, ethnicity, medical insurance, employment status, residential region, clinical factors, and comorbidities were considered as potential predictors of ESRD treatment choice, i.e., peritoneal dialysis (PD), hemodialysis (HD), or preemptive kidney transplantation in age-adjusted and multivariable-adjusted logistic regression analyses.

Results: Of the 11,317 individuals with incident LN ESRD, 82.0% initiated HD, 12.2% initiated PD, and 2.8% underwent preemptive kidney transplantation. Receiving initial PD was significantly associated with earlier calendar year, female sex, higher albumin and hemoglobin levels, and lower serum creatinine levels. African Americans (versus whites), Medicaid beneficiaries and those with no health insurance (versus private insurance), and those unemployed (versus employed) had significantly reduced PD initiation. Comorbidities including congestive heart failure, peripheral vascular disease, and the inability to ambulate were also associated with decreased PD. Many sociodemographic and clinical factors favoring PD were associated with preemptive kidney transplant (versus dialysis) as well.

Conclusion: Few patients with LN ESRD receive initial PD or preemptive kidney transplantation. Race, ethnicity, employment, and medical insurance type are strongly associated with initial kidney replacement therapy choice. Future studies need to investigate the appropriateness of sociodemographic and clinical variation and the comparative effectiveness of kidney replacement therapies for LN ESRD.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Chi-Square Distribution
  • Comorbidity
  • Employment / statistics & numerical data
  • Female
  • Healthcare Disparities / ethnology*
  • Humans
  • Insurance, Health / statistics & numerical data
  • Kidney Failure, Chronic / ethnology
  • Kidney Failure, Chronic / etiology
  • Kidney Failure, Chronic / therapy*
  • Kidney Transplantation / statistics & numerical data
  • Logistic Models
  • Lupus Nephritis / complications
  • Lupus Nephritis / ethnology
  • Lupus Nephritis / therapy*
  • Male
  • Middle Aged
  • Minority Groups / statistics & numerical data*
  • Odds Ratio
  • Patient Selection*
  • Peritoneal Dialysis / statistics & numerical data
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Registries
  • Renal Dialysis / statistics & numerical data
  • Renal Replacement Therapy / statistics & numerical data*
  • Sex Factors
  • Socioeconomic Factors
  • Time Factors
  • United States / epidemiology
  • Young Adult