Trends of preemptive kidney transplantation in lupus compared to other primary diseases leading to end stage kidney disease in the United States of America.

IF 1.9 4区 医学 Q3 RHEUMATOLOGY
Lupus Pub Date : 2025-07-01 Epub Date: 2025-05-20 DOI:10.1177/09612033251344189
Gabriel Contreras, Javier Pagan, Tali Elfassy, Miguel Bandes, Nicolas Bustamante, Mariella Ortigosa-Goggins, Laura Aponte Becerra, Jair Munoz Mendoza, Yelena Drexler, Shawn Alonso, David Roth
{"title":"Trends of preemptive kidney transplantation in lupus compared to other primary diseases leading to end stage kidney disease in the United States of America.","authors":"Gabriel Contreras, Javier Pagan, Tali Elfassy, Miguel Bandes, Nicolas Bustamante, Mariella Ortigosa-Goggins, Laura Aponte Becerra, Jair Munoz Mendoza, Yelena Drexler, Shawn Alonso, David Roth","doi":"10.1177/09612033251344189","DOIUrl":null,"url":null,"abstract":"<p><p>PurposeThe proportion of lupus patients with end-stage kidney disease (ESKD) undergoing preemptive kidney transplantation (PKT) is <5%, due to concern for poor outcomes. In this study, we estimate trends and the likelihood of PKT in lupus patients compared to non-lupus patients approaching ESKD. Additionally, we compare kidney allograft failure (KAF) and all-cause mortality in lupus and non-lupus recipients of PKT.MethodsWe included 33,415 lupus and 3,001,746 non-lupus incident ESKD patients from the United States Renal Data System (USRDS). Patients were stratified in 6 groups: lupus, polycystic kidney disease (PKD), other glomerular diseases (GD), diabetes (DM), hypertension (HTN), and other diseases (OD). Trends of PKT were assessed with Cochran-Armitage tests. KAF and mortality were compared stratifying by primary diagnosis leading to ESKD.FindingsPKT trends increased in the lupus (3.02% to 4.65%, <i>p</i> = 0.001), PKD (3.14% to 16.71%, <i>p</i> < 0.001), and GD (3.94% to 5.90%, <i>p</i> < 0.001) groups, but decreased in the DM (2.11% to 0.71%, <i>p</i> < 0.001), HTN (1.15% to 0.92%, <i>p</i> < 0.001) and OD (3.89% to 3.60%, <i>p</i> < 0.001) groups. KAF rate (per 100 patient-years) was similarly low in lupus (4.40), PKD (2.47), GD (4.28) and OD (4.84) recipients, and similarly high in DM (6.24) and HTN (7.42) recipients. Lupus compared to DM recipients of PKT had significantly lower risk of KAF in adjusted Cox models (Hazard Ratio [95% CI] 0.85 [0.76 to 0.95]). Mortality rate was similarly low in lupus (2.59), PKD (2.20), GD (2.62) and OD (2.99) recipients, and similarly high in HTN (6.39) and DM (6.49) recipients. Lupus compared to DM recipients of PKT had significantly lower risk of all-cause mortality in adjusted models (0.56 [0.50 to 0.64]).ConclusionPKT trends increased from 1985 to 2019 in patients with lupus, PKD and GD. PKT patients with lupus have lower risk of KAF and mortality compared to patients with DM.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"775-786"},"PeriodicalIF":1.9000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lupus","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/09612033251344189","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/5/20 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

PurposeThe proportion of lupus patients with end-stage kidney disease (ESKD) undergoing preemptive kidney transplantation (PKT) is <5%, due to concern for poor outcomes. In this study, we estimate trends and the likelihood of PKT in lupus patients compared to non-lupus patients approaching ESKD. Additionally, we compare kidney allograft failure (KAF) and all-cause mortality in lupus and non-lupus recipients of PKT.MethodsWe included 33,415 lupus and 3,001,746 non-lupus incident ESKD patients from the United States Renal Data System (USRDS). Patients were stratified in 6 groups: lupus, polycystic kidney disease (PKD), other glomerular diseases (GD), diabetes (DM), hypertension (HTN), and other diseases (OD). Trends of PKT were assessed with Cochran-Armitage tests. KAF and mortality were compared stratifying by primary diagnosis leading to ESKD.FindingsPKT trends increased in the lupus (3.02% to 4.65%, p = 0.001), PKD (3.14% to 16.71%, p < 0.001), and GD (3.94% to 5.90%, p < 0.001) groups, but decreased in the DM (2.11% to 0.71%, p < 0.001), HTN (1.15% to 0.92%, p < 0.001) and OD (3.89% to 3.60%, p < 0.001) groups. KAF rate (per 100 patient-years) was similarly low in lupus (4.40), PKD (2.47), GD (4.28) and OD (4.84) recipients, and similarly high in DM (6.24) and HTN (7.42) recipients. Lupus compared to DM recipients of PKT had significantly lower risk of KAF in adjusted Cox models (Hazard Ratio [95% CI] 0.85 [0.76 to 0.95]). Mortality rate was similarly low in lupus (2.59), PKD (2.20), GD (2.62) and OD (2.99) recipients, and similarly high in HTN (6.39) and DM (6.49) recipients. Lupus compared to DM recipients of PKT had significantly lower risk of all-cause mortality in adjusted models (0.56 [0.50 to 0.64]).ConclusionPKT trends increased from 1985 to 2019 in patients with lupus, PKD and GD. PKT patients with lupus have lower risk of KAF and mortality compared to patients with DM.

在美国,与其他导致终末期肾病的原发性疾病相比,狼疮患者先发制人肾移植的趋势。
目的狼疮终末期肾病(ESKD)患者行先行性肾移植(PKT)的比例为p = 0.001, PKD组为3.14% ~ 16.71%,p < 0.001, GD组为3.94% ~ 5.90%,p < 0.001, DM组为2.11% ~ 0.71%,p < 0.001, HTN组为1.15% ~ 0.92%,p < 0.001, OD组为3.89% ~ 3.60%,p < 0.001。狼疮(4.40)、PKD(2.47)、GD(4.28)和OD(4.84)受者的KAF率(每100患者年)同样低,DM(6.24)和HTN(7.42)受者的KAF率同样高。在调整后的Cox模型中,狼疮患者与接受PKT治疗的糖尿病患者相比,发生KAF的风险显著降低(风险比[95% CI] 0.85[0.76 ~ 0.95])。狼疮(2.59)、PKD(2.20)、GD(2.62)和OD(2.99)受者的死亡率同样低,HTN(6.39)和DM(6.49)受者的死亡率同样高。在调整后的模型中,狼疮患者与接受PKT治疗的糖尿病患者相比,全因死亡风险显著降低(0.56[0.50至0.64])。结论狼疮、PKD和GD患者的pkt趋势在1985 ~ 2019年呈上升趋势。与糖尿病患者相比,PKT合并狼疮患者发生KAF和死亡的风险较低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Lupus
Lupus 医学-风湿病学
CiteScore
4.20
自引率
11.50%
发文量
225
审稿时长
1 months
期刊介绍: The only fully peer reviewed international journal devoted exclusively to lupus (and related disease) research. Lupus includes the most promising new clinical and laboratory-based studies from leading specialists in all lupus-related disciplines. Invaluable reading, with extended coverage, lupus-related disciplines include: Rheumatology, Dermatology, Immunology, Obstetrics, Psychiatry and Cardiovascular Research…
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信