title: Cardiovascular and cerebrovascular morbidity and mortality among women with end-stage renal disease attributable to lupus nephritis.
abstract: Cardiovascular and cerebrovascular diseases are common causes of morbidity and mortality in women with systemic lupus erythematosus (SLE) and are also common in patients with end-stage renal disease (ESRD). To determine whether women with ESRD caused by lupus nephritis are at greater risk for morbidity from these conditions than women with other causes of ESRD, data from the US Renal Data System were used to compare incidence rates of hospitalizations for acute myocardial infarction and cerebrovascular accident between women with ESRD caused by lupus nephritis and women with ESRD from other causes. The age- and race-adjusted incidences of hospitalizations for acute myocardial infarction during dialysis were 16.4 hospitalizations/1,000 patient-years among women with ESRD caused by lupus nephritis and 17.3 hospitalizations/1,000 patient-years among women in the comparison group (adjusted hazard ratio, 0.80; 95% confidence interval [CI], 0.58 to 1.08; P = 0.14). Adjusted incidence rates for acute myocardial infarction after renal transplantation also did not differ between these groups. Adjusted incidence rates for hospitalizations for cerebrovascular accident during dialysis were 18.5 hospitalizations/1,000 patient-years among women with ESRD caused by lupus nephritis and 19.2 hospitalizations/1,000 patient-years among women in the comparison group (adjusted hazard ratio, 0.87; 95% CI, 0.66 to 1.14; P = 0.30); incidence rates after transplantation also did not differ between groups. Risks for death from cardiovascular or cerebrovascular diseases also were not increased among women with ESRD caused by lupus nephritis. Sepsis was the most common cause of death in this group. Morbidity and mortality from acute myocardial infarction and cerebrovascular accident were substantially greater among women with ESRD caused by diabetes mellitus. Although morbidity and mortality from cardiovascular and cerebrovascular diseases are common among women with SLE, risks for these outcomes are not greater among women with ESRD caused by lupus nephritis than among other women without diabetes with ESRD.
authors.affiliation: Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94305, USA. mward@leland.stanford.edu
authors.forename: M M
authors.initials: MM
authors.lastname: Ward
mesh_terms: D000328:Adult; D000368:Aged; D019992:Databases as Topic; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality; D016030:Kidney Transplantation / Q000401:mortality; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000401:mortality; D008181:Lupus Nephritis / Q000150:complications* / Q000401:mortality / Q000628:therapy; D008875:Middle Aged; D009017:Morbidity; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality