title: End-stage renal disease due to lupus nephritis among children in the US, 1995-2006.
abstract: OBJECTIVE
  To identify predictors of wait-listing for kidney transplantation, kidney transplantation, and mortality among children with lupus nephritis-associated end-stage renal disease (ESRD).
  
  
  METHODS
  Children ages 5-18 years with new-onset lupus nephritis-associated ESRD were identified in the US Renal Data System (1995-2006). Demographic and clinical characteristics, causes of death, and predictors of wait-listing for kidney transplantation, kidney transplantation, and mortality during the first 5 years of ESRD were investigated. Cox proportional hazards models were used.
  
  
  RESULTS
  A total of 583 children had incident lupus nephritis-associated ESRD. The mean ± SD age of the patients at the time of ESRD onset was 16.2 ± 2.4 years; 49% were African American, and 24% were Hispanic. During the 5-year period after the onset of ESRD, 292 (49%) were wait-listed, 193 (33%) received a kidney transplant, and 131 (22%) died. The main causes of death were cardiopulmonary (31%) and infectious (16%). Children living in the northeast and west were more than twice as likely as children in the south to be wait-listed and were >50% more likely than children in the south to undergo transplantation. There were fewer kidney transplants among older versus younger patients (odds ratio [OR] 0.59, P = 0.009), African American versus white patients (OR 0.48, P < 0.001), Hispanic versus non-Hispanic patients (OR 0.63, P = 0.03), and those with Medicaid versus those with private insurance (OR 0.70, P = 0.03). Mortality among African American children was almost double that among white children (OR 1.83, P < 0.001).
  
  
  CONCLUSIONS
  Among US children with lupus nephritis-associated ESRD, age, race, ethnicity, type of medical insurance, and geographic region were associated with significant variation in 5-year wait-listing for kidney transplantation, kidney transplantation, and mortality.
authors: Harvard School of Public Health and Brigham and Women's Hospital, Boston, Massachusetts, USA. lhiraki@hsph.harvard.edu
authors: Linda T
authors: LT
authors: Hiraki
authors: Bing
authors: B
authors: Lu
authors: Steven R
authors: SR
authors: Alexander
authors: Tamara
authors: T
authors: Shaykevich
authors: Graciela S
authors: GS
authors: Alarcón
authors: Daniel H
authors: DH
authors: Solomon
authors: Wolfgang C
authors: WC
authors: Winkelmayer
authors: Karen H
authors: KH
authors: Costenbader
mesh_terms: D000293:Adolescent; D001741:Black or African American; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D016030:Kidney Transplantation; D008181:Lupus Nephritis / Q000150:complications* / Q000401:mortality / Q000601:surgery; D008297:Male; D016017:Odds Ratio; D012307:Risk Factors; D014481:United States