Lupus nephritis carries higher adverse outcomes in kids on dialysis

Among children and adolescents undergoing maintenance dialysis, those with lupus nephritis are at higher risk of adverse outcomes, including hospitalization, and are less likely to receive kidney transplantation compared with those who have non-lupus glomerular disease, a study has found.

The study used data from the North American Pediatric Renal Trials and Collaborative Studies registry and included children aged 6–20 years who were initiated on maintenance dialysis. There were 231 children with lupus nephritis and 1,1726 with non-lupus glomerular disease.

To compare outcomes, including hospitalization, mortality, and time to transplant, researchers used contingency tables and applied multivariable Cox regression and logistic regression models.

Results revealed that compared with children with non-lupus glomerular disease, those with lupus nephritis were more commonly hospitalized in the first year after dialysis initiation (63.3 percent vs 48.6 percent; p<0.001) and less likely to receive a kidney transplant in the first 3 years after dialysis initiation (year 0–1: adjusted hazard ratio [aHR], 0.36, 95 percent confidence interval [CI], 0.23–0.57; p<0.001; year 1–3: aHR, 0.73, 95 percent CI, 0.54–0.98; p=0.04).

Anaemia conferred a more than fourfold greater odds of hospitalization after dialysis initiation (adjusted odds ratio, 4.44, 95 percent CI, 1.44–13.66; p=0.01), whereas non-White race was associated with a lower rate of kidney transplantation (aHR, 0.47, 95 percent CI, 0.27–0.82; p=0.01). Lupus nephritis did not contribute to an increased risk of death while on dialysis (aHR, 1.21, 95 percent CI, 0.47–3.11; p=0.7).

The study was limited by the inability to collect information on lupus disease activity and medication use and doses.