title: Racial differences and income disparities are associated with poor outcomes in kidney transplant recipients with lupus nephritis.
abstract: BACKGROUND
  An analysis of income and racial/ethnic disparities on renal transplant outcomes in recipients with lupus nephritis (LN) has not been reported. We analyzed the United States Renal Data System database to assess the impact of these disparities on graft loss and death in the LN and non-LN cohorts.
  
  
  METHODS
  We identified 4214 patients with LN as the cause of end-stage renal disease in a retrospective cohort of 150,118 patients first transplanted from January 1, 1995 to July 1, 2006. We merged data on median household income from the United States Census based on the ZIP code.
  
  
  RESULTS
  In multivariate Cox regression analyses, African-Americans (AF) recipients with LN (vs. non-AF) had an increased risk of graft loss (adjusted hazard ratio [AHR], 1.39; 95% confidence interval [CI], 1.21-1.60) and death (AHR, 1.33; 95% CI, 1.09-1.63). Furthermore, there were significant associations of lower-income quintiles with higher risk for graft loss and death among AF with LN. In comparison, among non-AF recipients with LN, income levels did not predict risk for transplant outcomes. The racial disparity for both graft loss and death outcomes among AF with LN was greater than among AF without LN (AHR, 1.32; 95% CI, 1.29-1.36 for graft loss and AHR, 1.02; 95% CI, 0.99-1.05 for death).
  
  
  CONCLUSIONS
  AF kidney transplant recipients with LN were at increased risk for graft loss and death compared with non-AF. Income levels were associated with the risk of graft loss and death in AF but not in non-AF recipients with LN.
authors.affiliation: Nephrology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Nee
authors.forename: Rahul M
authors.initials: RM
authors.lastname: Jindal
authors.forename: Dustin
authors.initials: D
authors.lastname: Little
authors.forename: Rosalind
authors.initials: R
authors.lastname: Ramsey-Goldman
authors.forename: Lawrence
authors.initials: L
authors.lastname: Agodoa
authors.forename: Frank P
authors.initials: FP
authors.lastname: Hurst
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Abbott
mesh_terms: D000328:Adult; D001741:Black or African American; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy; D016030:Kidney Transplantation; D008181:Lupus Nephritis / Q000453:epidemiology / Q000208:ethnology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012923:Social Class; D016896:Treatment Outcome