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":"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。","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":"{\"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}","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}
Trends of preemptive kidney transplantation in lupus compared to other primary diseases leading to end stage kidney disease in the United States of America.
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.
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…