title: Risk of End-Stage Renal Disease in Patients With Lupus Nephritis, 1971-2015: A Systematic Review and Bayesian Meta-Analysis.
abstract: End-stage renal disease (ESRD) is a major consequence of lupus nephritis, but how this risk has changed over time is unknown. We conducted this systematic review to examine changes in ESRD among adults with lupus nephritis from 1971 to 2015 and to estimate risks of ESRD among contemporary patients.
  
  
  
  We searched PubMed, Embase, and the Cochrane Database of Systematic Reviews for cohort studies and clinical trials on ESRD in adults with lupus nephritis. We analyzed studies from developed and developing countries separately. The outcome was probability of ESRD at 5, 10, and 15 years of lupus nephritis.
  
  
  
  We included 187 articles that reported on 18,309 patients. In developed countries, the 5-year risk of ESRD decreased from 16% (95% confidence interval [95% CI] 14-17%) in 1970-1979 to 11% (95% CI 10-12%) in the mid-1990s and then plateaued. ESRD risks at 10 years and 15 years showed steeper declines in the 1970s and 1980s but also plateaued in 1993-1997, with a notable increase in the late 2000s. The decrease in risk after 1980 coincided with increased use of cyclophosphamide. The 15-year ESRD risk was higher in developing countries than in developed countries. Patients with class IV lupus nephritis had the greatest risk of ESRD, with a 15-year risk of 44% during the 2000s.
  
  
  
  Risks of ESRD in lupus nephritis improved between the 1970s and the mid-1990s and then plateaued, with an increase in the late 2000s. This pattern suggests limitations in the effectiveness of, or access to, current treatments.
authors.affiliation: University of Athens School of Medicine, Athens, Greece.
authors.forename: Maria G
authors.initials: MG
authors.lastname: Tektonidou
authors.affiliation: National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland.
authors.forename: Abhijit
authors.initials: A
authors.lastname: Dasgupta
authors.affiliation: National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Ward
mesh_terms: D001499:Bayes Theorem; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000209:etiology*; D008181:Lupus Nephritis / Q000150:complications*; D018570:Risk Assessment; D013997:Time Factors
references.citation: Cochrane Database Syst Rev. 2012 Dec 12;12 :CD002922
references.pmid: 23235592
references.citation: Kidney Int. 2001 Jun;59(6):2156-63
references.pmid: 11380817
references.citation: Lupus. 1995 Apr;4(2):109-15
references.pmid: 7795613
references.citation: Medicine (Baltimore). 2003 Sep;82(5):299-308
references.pmid: 14530779
references.citation: N Engl J Med. 1984 Dec 13;311(24):1528-33
references.pmid: 6390198
references.citation: Am J Med. 1991 Oct;91(4):345-53
references.pmid: 1951378
references.citation: Arthritis Res Ther. 2012;14 Suppl 4:S4
references.pmid: 23281889
references.citation: Curr Opin Rheumatol. 2001 Sep;13(5):345-51
references.pmid: 11604587
references.citation: Am J Kidney Dis. 2013 Apr;61(4 Suppl 2):S24-32
references.pmid: 23507267
references.citation: Lancet. 2007 Sep 8;370(9590):841-50
references.pmid: 17826169
references.citation: Arthritis Rheum. 1994 Mar;37(3):359-68
references.pmid: 8129791
references.citation: Ann Rheum Dis. 2012 Nov;71(11):1771-82
references.pmid: 22851469
references.citation: PLoS Med. 2006 Oct;3(10):e396
references.pmid: 17076550
references.citation: Kidney Int. 1997 Apr;51(4):1188-95
references.pmid: 9083285
references.citation: J Rheumatol. 2008 Nov;35(11):2152-8
references.pmid: 18793004
references.citation: JAMA. 2000 Apr 19;283(15):2008-12
references.pmid: 10789670
references.citation: PLoS Med. 2009 Jul 21;6(7):e1000100
references.pmid: 19621070
references.citation: Lupus. 2010 Apr;19(5):557-74
references.pmid: 20089610
references.citation: J Rheumatol. 2010 Jun;37(6):1158-63
references.pmid: 20395647
references.citation: Lupus. 2013 Jul;22(8):810-8
references.pmid: 23764764
references.citation: Arthritis Care Res (Hoboken). 2010 Jun;62(6):873-80
references.pmid: 20191478
references.citation: Am J Kidney Dis. 2008 Apr;51(4):563-72
references.pmid: 18371532
references.citation: Rheumatology (Oxford). 2011 Aug;50(8):1424-30
references.pmid: 21415024
references.citation: Arthritis Rheum. 2009 Jun 15;61(6):755-63
references.pmid: 19479688
references.citation: BMC Med Res Methodol. 2012 Feb 01;12:9
references.pmid: 22297116
references.citation: J Rheumatol. 2009 Jan;36(1):63-7
references.pmid: 19004042
references.citation: Ann Rheum Dis. 2003 May;62(5):435-9
references.pmid: 12695156
references.citation: JAMA. 2013 Apr 17;309(15):1613-21
references.pmid: 23592106
references.citation: Nephrol Dial Transplant. 2007 Sep;22(9):2531-9
references.pmid: 17510096
references.citation: Arthritis Care Res (Hoboken). 2012 Jun;64(6):797-808
references.pmid: 22556106
references.citation: Int J Nephrol Renovasc Dis. 2013 Nov 22;6:249-58
references.pmid: 24294005
references.citation: Arthritis Rheum. 2009 Feb 15;61(2):240-6
references.pmid: 19177526
references.citation: Am J Med. 1987 Nov;83(5):877-85
references.pmid: 3674094
references.citation: Arch Intern Med. 1992 Oct;152(10):2082-8
references.pmid: 1417382
references.citation: J Rheumatol. 2007 Oct;34(10):2024-7
references.pmid: 17696272
references.citation: Int Urol Nephrol. 2013 Oct;45(5):1289-300
references.pmid: 23306862
references.citation: Nephrol Dial Transplant. 2012 Aug;27(8):3248-54
references.pmid: 22523116
references.citation: N Engl J Med. 1986 Mar 6;314(10):614-9
references.pmid: 3511372