title: Incidence of progression from newly diagnosed systemic lupus erythematosus to end stage renal disease and all-cause mortality: a nationwide cohort study in Taiwan.
abstract: OBJECTIVE
  End-stage renal disease (ESRD) is a common finding in systemic lupus erythematosus (SLE) and may contribute to mortality. The purpose of the study was to investigate the incidence of ESRD and all-cause mortality and their risk factors in patients newly diagnosed with SLE in Taiwan.
  
  
  METHODS
  This nationwide cohort study used data from the National Health Insurance Research Database. We identified 4130 newly diagnosed SLE patients at risk for ESRD during 2000-2002; among them, 103 developed ESRD by the end of 2008. Additional 412 age- and sex-matched incident ESRD non-SLE patients served as controls for the survival analysis.
  
  
  RESULTS
  Of the newly diagnosed SLE patients, 2.5% developed ESRD. Age (adjusted hazards ratio [HR] 0.66 for each 1-year increase; 95% confidence interval [CI] 0.47-0.94) and male gender (adjusted HR 2.24; 95% CI 1.4-3.6) were significantly associated with ESRD development. Survival analysis conducted after ESRD development revealed a higher mortality risk among the older patients (HR 1.04; 95% CI 1.02-1.05). Survival analysis in the younger population (age < 40 years) after ESRD development revealed a significant mortality risk among SLE patients (HR 2.73; 95% CI 1.22-6.07).
  
  
  CONCLUSIONS
  In the follow-up of newly diagnosed SLE patients in Taiwan, younger age and male gender were risk factors for ESRD development. After entering ESRD, these risk factors had different impacts on mortality. Despite the overall improvement in care of patients with lupus nephritis, survival is still poorer in the younger age population.
authors.affiliation: Institute of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Wei-Hung
authors.initials: WH
authors.lastname: Lin
authors.forename: Chao-Yu
authors.initials: CY
authors.lastname: Guo
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Wang
authors.forename: Deng-Chi
authors.initials: DC
authors.lastname: Yang
authors.forename: Te-Hui
authors.initials: TH
authors.lastname: Kuo
authors.forename: Ming-Fei
authors.initials: MF
authors.lastname: Liu
authors.forename: Ming-Cheng
authors.initials: MC
authors.lastname: Wang
mesh_terms: D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D002423:Cause of Death; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors
keywords: end-stage renal disease; mortality; national health insurance; systemic lupus erythematosus