title: Comparison of quality-of-care measures in U.S. patients with end-stage renal disease secondary to lupus nephritis vs. other causes.
abstract: BACKGROUND
  Patients with end-stage renal disease (ESRD) due to lupus nephritis (LN-ESRD) may be followed by multiple providers (nephrologists and rheumatologists) and have greater opportunities to receive recommended ESRD-related care. We aimed to examine whether LN-ESRD patients have better quality of ESRD care compared to other ESRD patients.
  
  
  METHODS
  Among incident patients (7/05-9/11) with ESRD due to LN (n = 6,594) vs. other causes (n = 617,758), identified using a national surveillance cohort (United States Renal Data System), we determined the association between attributed cause of ESRD and quality-of-care measures (pre-ESRD nephrology care, placement on the deceased donor kidney transplant waitlist, and placement of permanent vascular access). Multivariable logistic and Cox proportional hazards models were used to estimate adjusted odds ratios (ORs) and hazard ratios (HRs).
  
  
  RESULTS
  LN-ESRD patients were more likely than other ESRD patients to receive pre-ESRD care (71% vs. 66%; OR = 1.68, 95% CI 1.57-1.78) and be placed on the transplant waitlist in the first year (206 vs. 86 per 1000 patient-years; HR = 1.42, 95% CI 1.34-1.52). However, only 24% had a permanent vascular access (fistula or graft) in place at dialysis start (vs. 36%; OR = 0.63, 95% CI 0.59-0.67).
  
  
  CONCLUSIONS
  LN-ESRD patients are more likely to receive pre-ESRD care and have better access to transplant, but are less likely to have a permanent vascular access for dialysis, than other ESRD patients. Further studies are warranted to examine barriers to permanent vascular access placement, as well as morbidity and mortality associated with temporary access, in patients with LN-ESRD.
authors.affiliation: Department of Medicine, Emory University, Atlanta, Georgia, USA. laura.plantinga@emory.edu.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Plantinga
authors.affiliation: Department of Surgery, Emory University, Atlanta, Georgia, USA. rpatzer@emory.edu.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Patzer
authors.affiliation: Department of Medicine, Emory University, Atlanta, Georgia, USA. cdrenka@emory.edu.
authors.forename: Cristina
authors.initials: C
authors.lastname: Drenkard
authors.affiliation: Department of Medicine, Emory University, Atlanta, Georgia, USA. Stephen.Pastan@emoryhealthcare.org.|Emory Transplant Center, Emory Healthcare, Atlanta, Georgia, USA. Stephen.Pastan@emoryhealthcare.org.
authors.forename: Stephen O
authors.initials: SO
authors.lastname: Pastan
authors.affiliation: Department of Medicine, Emory University, Atlanta, Georgia, USA. jcobb2@emory.edu.
authors.forename: Jason
authors.initials: J
authors.lastname: Cobb
authors.affiliation: Department of Epidemiology, Emory University, Atlanta, Georgia, USA. wmcclel@emory.edu.
authors.forename: William
authors.initials: W
authors.lastname: McClellan
authors.affiliation: Department of Medicine, Emory University, Atlanta, Georgia, USA. sslim@emory.edu.
authors.forename: Sung Sam
authors.initials: SS
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation / Q000592:standards* / Q000639:trends; D016015:Logistic Models; D008181:Lupus Nephritis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010348:Patient Care Team / Q000458:organization & administration*; D016016:Proportional Hazards Models; D011787:Quality of Health Care; D006435:Renal Dialysis / Q000592:standards* / Q000639:trends; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States; D014850:Waiting Lists