title: Long-term outcomes of end-stage kidney disease for patients with lupus nephritis.
abstract: Patient outcomes in end-stage kidney disease (ESKD) secondary to lupus nephritis have not been well described. To help define this we compared dialysis and transplant outcomes of patients with ESKD due to lupus nephritis to all other causes. All patients diagnosed with ESKD who commenced renal replacement therapy in Australia and New Zealand (1963-2012) were included. Clinical outcomes were evaluated in both a contemporary cohort (1998-2012) and the entire 50-year cohort. Of 64,160 included patients, 744 had lupus nephritis as the primary renal disease. For the contemporary cohort of 425 patients with lupus nephritis, the 5-year dialysis patient survival rate was 69%. Of 176 contemporary patients with lupus nephritis who received their first renal allograft, the 5-year patient, overall renal allograft, and death-censored renal allograft survival rates were 95%, 88%, and 93%, respectively. Patients with lupus nephritis had worse dialysis patient survival (adjusted hazard ratio 1.33, 95% confidence interval 1.12-1.58) and renal transplant patient survival (adjusted hazard ratio 1.87, 95% confidence interval 1.18-2.98), but comparable overall renal allograft survival (adjusted hazard ratio 1.19, 95% confidence interval 0.84-1.68) and death-censored renal allograft survival (adjusted hazard ratio 1.05, 95% confidence interval 0.68-1.62) compared with ESKD controls. Similar results were found in the entire cohort and when using competing-risks analysis. Thus, the ESKD of lupus nephritis was associated with worse dialysis and transplant patient survival but comparable renal allograft survival compared with other causes of ESKD.
authors.affiliation: Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Gavin
authors.initials: G
authors.lastname: Lee
authors.affiliation: Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.
authors.forename: Xusheng
authors.initials: X
authors.lastname: Liu
authors.affiliation: Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia; School of Medicine, The University of Queensland, Queensland, Australia.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Pascoe
authors.affiliation: Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Badve
authors.affiliation: Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia; School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, The University of Western Australia, Perth, Australia.
authors.forename: Neil C
authors.initials: NC
authors.lastname: Boudville
authors.affiliation: Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia; Department of Nephrology, Prince of Wales Hospital, Sydney, Australia; School of Public Health, University of Sydney, Sydney, Australia.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Clayton
authors.affiliation: Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hawley
authors.affiliation: Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia; Department of Nephrology, Monash Health and Department of Medicine, Monash University-Melbourne, Melbourne, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Kanellis
authors.affiliation: Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia; School of Medicine, University of Adelaide, Adelaide, Australia.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: McDonald
authors.affiliation: School of Medicine, University of Adelaide, Adelaide, Australia.
authors.forename: Chen Au
authors.initials: CA
authors.lastname: Peh
authors.affiliation: Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia; Department of Nephrology, Monash Health and Department of Medicine, Monash University-Melbourne, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Kevan R
authors.initials: KR
authors.lastname: Polkinghorne
authors.affiliation: Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Queensland, Australia. Electronic address: david.johnson2@health.qld.gov.au.
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy*; D016030:Kidney Transplantation / Q000401:mortality*; D008181:Lupus Nephritis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014184:Transplantation, Homologous / Q000401:mortality
keywords: dialysis; disease recurrence; end-stage kidney disease; kidney transplantation; outcomes; renal transplantation; systemic lupus erythematosus