title: End-stage renal disease in patients with rheumatoid arthritis.
abstract: To determine the frequency of end-stage renal disease (ESRD) in patients with rheumatoid arthritis (RA), the causes of ESRD, and the treatment of RA in the setting of ESRD.
  
  
  
  Cross-sectional study of RA (N = 3754) and non-RA (N = 326,776) patients in the United States Renal Data System (USRDS) during 2011 (N = 330,530). The epidemiology of ESRD in RA was determined and the etiology of ESRD in patients with and without RA was compared. The frequency of patients with RA with at least one filled prescription for prednisone/prednisolone, a DMARD, and/or a biologic in 2011 was determined.
  
  
  
  The prevalence of RA with ESRD in the USRDS in 2011 was 1.1%. There were significant differences in age, race, sex, and BMI category between the groups (p < 0.01). Diabetes (33.5%) and hypertension (30.6%) were the most common primary causes of ESRD in patients with RA. Amyloidosis, vasculitis, and analgesic nephropathy combined accounted for less than 10% of cases of ESRD. Prednisone was the most commonly filled medication that could be used to treat RA (45.9% of RA patients). Hydroxychloroquine was the most frequently filled DMARD (13.5%); biologics were uncommon (etanercept 2.5%, adalimumab 1.5%; golimumab, infliximab, anakinra, and abatacept <1%).
  
  
  
  The co-occurrence of RA with ESRD was 1.1% in the USRDS by 2011. Physicians should be aware of the critical impact of the comorbidities of diabetes and hypertension in causing ESRD in RA patients. Use of DMARDS other than hydroxychloroquine and biologics to treat RA in the setting of ESRD appears to be infrequent. Further prospective studies of treatment strategies for RA in ESRD are needed.
authors: Division of Rheumatology, University of South Carolina School of Medicine, 2 Medical Park, Columbia, SC 29203. Electronic address: sunita.paudyal@uscmed.sc.edu.
authors: Sunita
authors: S
authors: Paudyal
authors: Department of Biostatistics, Augusta University, Augusta, GA.
authors: Frances M
authors: FM
authors: Yang
authors: Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA.
authors: Christopher
authors: C
authors: Rice
authors: Department of Biostatistics, Augusta University, Augusta, GA.
authors: Chen-Chun
authors: CC
authors: Chen
authors: Department of Biostatistics, Augusta University, Augusta, GA.
authors: Michael
authors: M
authors: Skelton
authors: Department of Biostatistics, Augusta University, Augusta, GA.
authors: Monique
authors: M
authors: Bethel
authors: Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA.
authors: Shilpa
authors: S
authors: Brown
authors: Division of Nephrology, Medical College of Georgia, Augusta University, Augusta, GA; Charlie Norwood Veterans Affairs Medical Center, Specialty Care, Augusta, GA.
authors: Norris Stanley
authors: NS
authors: Nahman
authors: Charlie Norwood Veterans Affairs Medical Center, Specialty Care, Augusta, GA; Division of Rheumatology and Adult Allergy, Department of Medicine, Division of Rheumatology and Adult Allergy, Medical College of Georgia, Augusta University, Augusta, GA.
authors: Laura
authors: L
authors: Carbone
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000686:Amyloidosis / Q000150:complications; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000453:epidemiology*; D001688:Biological Products / Q000627:therapeutic use; D016022:Case-Control Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003928:Diabetic Nephropathies / Q000453:epidemiology; D000068800:Etanercept / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D006973:Hypertension / Q000150:complications; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D015995:Prevalence; D014481:United States / Q000453:epidemiology; D014657:Vasculitis / Q000150:complications; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D005938:Glucocorticoids; D006886:Hydroxychloroquine; D000068879:Adalimumab; D000068800:Etanercept; D011241:Prednisone
keywords: Biologics; DMARDs; End-stage renal disease; Prednisone; Rheumatoid arthritis