title: Racial and Ethnic Differences in Mortality and Cardiovascular Events Among Patients With End-Stage Renal Disease Due to Lupus Nephritis.
abstract: OBJECTIVE
  To identify racial and ethnic differences in mortality and cardiovascular (CV) risk among patients with end-stage renal disease (ESRD) due to lupus nephritis (LN).
  
  
  METHODS
  Within the US ESRD registry (1995-2008), we identified individuals ages >17 years with incident ESRD due to systemic lupus erythematosus. We ascertained demographics, clinical factors, and deaths from registry patient files and CV events (myocardial infarction, heart failure, and hemorrhagic and ischemic strokes) from inpatient Medicare claims. We calculated incidence rates (95% confidence intervals [95% CIs]) per 1,000 person-years for study events, stratified by race and ethnicity. We compared probabilities of the events among racial and ethnic groups using cumulative incidence function curves and multivariable-adjusted subdistribution proportional hazard ratios (HRsd), taking into account the competing events of kidney transplantation and death (for nonfatal CV events).
  
  
  RESULTS
  Of 12,533 patients with LN-associated ESRD, the mean ± SD age was 40.7 ± 14.9 years, 82% were women, and 49% were African American. The overall mortality rate was 98.1/1,000 person-years (95% CI 95.3-100.9). In multivariable models, Asian and Hispanic LN-associated ESRD patients had lower mortality than whites (HRsd 0.70 [95% CI 0.58-0.84] and 0.79 [95% CI 0.71-0.88], respectively), whereas African Americans had higher mortality (HRsd 1.27 [95% CI 1.18-1.36]). African American patients >40 years old had higher mortality than their white counterparts (HRsd 1.67 [95% CI 1.44-1.93]). African Americans were more likely to be admitted for heart failure or hemorrhagic stroke.
  
  
  CONCLUSIONS
  Among patients with LN-associated ESRD, Asians and Hispanics experienced lower mortality and CV event risks than whites, and African Americans had higher mortality and CV event risks than whites.
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Gómez-Puerta
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Candace H
authors.initials: CH
authors.lastname: Feldman
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Graciela S
authors.initials: GS
authors.lastname: Alarcón
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Hongshu
authors.initials: H
authors.lastname: Guan
authors.affiliation: Baylor College of Medicine, Houston, Texas.
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Karen H
authors.initials: KH
authors.lastname: Costenbader
mesh_terms: D000328:Adult; D000367:Age Factors; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000209:etiology / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000209:etiology / Q000401:mortality*; D008181:Lupus Nephritis / Q000150:complications / Q000208:ethnology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D044469:Racial Groups / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D014481:United States; D055815:Young Adult