title: Outcome of lupus nephritis after entering into end-stage renal disease and comparison between different treatment modalities: a nationwide population-based cohort study in Taiwan.
abstract: BACKGROUND
  Systemic lupus erythematosus (SLE) is not a rare disease among the Chinese and the incidence is higher in the female population. Lupus nephritis (LN) often develops in patients with SLE and may progress to end-stage renal disease (ESRD). Although there are studies that suggest postponement of the scheduling of kidney transplantation (KT) for these patients, there are still some other studies with conflicting results. Our study aimed to analyze the outcome of patients with LN after progression to ESRD and to try to elucidate whether deferral of KT is necessary in the Chinese population.
  
  
  METHODS
  We used the National Health Insurance Research Database to perform this cohort study. The study cohort was observed between 1998 and 2009 after being diagnosed as having SLE. The cases of SLE and ESRD were identified according to the catastrophic illness database.
  
  
  RESULTS
  In total, 1998 SLE patients with ESRD were identified. They received hemodialysis, peritoneal dialysis, or KT with the proportion of 82.1%, 9.8%, and 8.1%, respectively. The 1-year, 5-year, 10-year patient survival rates were best for those who underwent KT (100%, 98.1%, and 94.4%, respectively), followed by peritoneal dialysis (88.3%, 79.1%, and 76%, respectively), and hemodialysis (53.6%, 46.0%, and 41.6%, respectively). For those who underwent KT within 1 year after ESRD, no significant worse patient survival and graft survival were observed than those who underwent KT 1 year later.
  
  
  CONCLUSIONS
  KT provides a better survival benefit for SLE patients with ESRD than hemodialysis and peritoneal dialysis. No obvious clinical benefit of KT deferral was observed in our study and the deferral may not be necessary for our population.
authors.affiliation: Division of Nephrology, Department of Medicine, Taiwan; School of Medicine, Chung Shan Medical University, Taiwan; Graduate Institute of Clinical Medical Science, School of Medicine, China Medical University, Taiwan; Institute of Biomedical Science, National Chung Hsing University, Taiwan; Department of Life Science, Tunghai University, Taichung, Taiwan. Electronic address: wmj530@gmail.com.
authors.forename: M-J
authors.initials: MJ
authors.lastname: Wu
authors.affiliation: Division of Nephrology, Department of Medicine, Taiwan; Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Y-C
authors.initials: YC
authors.lastname: Lo
authors.affiliation: School of Medicine, Chung Shan Medical University, Taiwan.
authors.forename: J-L
authors.initials: JL
authors.lastname: Lan
authors.affiliation: Division of Nephrology, Department of Medicine, Taiwan.
authors.forename: T-M
authors.initials: TM
authors.lastname: Yu
authors.affiliation: Division of Nephrology, Department of Medicine, Taiwan.
authors.forename: K-H
authors.initials: KH
authors.lastname: Shu
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taiwan.
authors.forename: D-Y
authors.initials: DY
authors.lastname: Chen
authors.affiliation: Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taiwan.
authors.forename: H-C
authors.initials: HC
authors.lastname: Ho
authors.affiliation: Department of Medical Research, Taichung Veterans General Hospital, Taiwan.
authors.forename: C-H
authors.initials: CH
authors.lastname: Lin
authors.affiliation: Department of Medical Research, Taichung Veterans General Hospital, Taiwan.
authors.forename: S-N
authors.initials: SN
authors.lastname: Chang
mesh_terms: D000328:Adult; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy*; D008181:Lupus Nephritis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D013624:Taiwan; D055815:Young Adult