Most lupus nephritis patients with end-stage renal disease opt for hemodialysis therapy

November 07, 2011

Newly published research shows that more patients with end-stage renal disease (ESRD) caused by lupus nephritis choose hemodialysis as their initial kidney replacement therapy over peritoneal dialysis and preemptive kidney transplantation. Results of the study now available in Arthritis Care & Research, a journal of the American College of Rheumatology (ACR), also found that African Americans, Medicaid recipients, those without health insurance, and the unemployed had significantly reduced initiation of peritoneal dialysis.

According to ACR estimates up to 322,000 adult Americans have systemic lupus erythematosus--a chronic autoimmune disease where the immune system becomes overactive and creates antibodies that attack healthy tissues and organs. When inflammation of the kidneys occurs, known as lupus nephritis, patients are at risk of ESRD. Previous studies report that as many as 60% of lupus patients develop nephritis, with roughly 20% of these cases advancing to ESRD over a 10-year period. Lupus patients with nephritis who progress to ESRD must select kidney replacement options such as hemodialysis, peritoneal dialysis, or kidney transplantation.

"Our study is the first and largest observational investigation of initial kidney replacement therapies selected by patients with lupus nephritis ESRD," said Dr. Karen Costenbader, the study's senior author and rheumatologist at the Brigham and Women's Hospital Lupus Center in Boston, Massachusetts. Using the U.S. Renal Data System (USRDS), researchers identified 11,317 patients with ESRD caused by lupus nephritis, between 1995 and 2006. The USRDS tracks information on ESRD patients in the U.S. who receive dialysis or kidney transplantation. Clinical and sociodemographic information was examined to determine the use patterns of kidney replacement therapies.

Study findings indicate that 82% of subjects initiated hemodialysis, 12% used peritoneal dialysis, while only 3% went straight to kidney transplantation without any type of dialysis. Those receiving peritoneal dialysis--an at home process that allows patients to filter out toxins from the blood using a catheter that has been surgically implanted into the abdomen--were more likely to be female and White, and to have private insurance compared to Medicare or no insurance. Those patients who were employed, had higher levels of albumin and hemoglobin levels, and lower levels of creatinine in the blood--all indicators of better health status--were also more likely to use an at home renal replacement method.

In 2011 the Centers for Medicare and Medicaid Services changed its payment policy for ESRD and now provide strong incentive for at home peritoneal dialysis. "Our findings show choice of kidney replacement therapy is closely linked to race, ethnicity, employment status and medical insurance type," concluded Dr. Costenbader. "Given the added incentives from healthcare coverage providers, knowledge of the social and demographic characteristics involved with dialysis choice provides rheumatologists with greater insight for treating lupus nephritis patients with ESRD." The authors recommend future studies compare the effectiveness of kidney replacement therapies and examine the sociodemographic variations involved in selecting the appropriate type of therapy.
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This study is published in Arthritis Care & Research. Media wishing to receive a PDF of this article may contact healthnews@wiley.com.

Full citation: "Variation in Initial Kidney Replacement Therapy for End-Stage Renal Disease Due to LN in the U.S." Amy Devlin, Sushrut Waikar, Daniel H. Solomon, Bing Lu, Tamara Shakevich, Graciela S. Alarcón, Wolfgang C. Winkelmayer, and Karen H. Costenbader. Arthritis Care and Research; Published Online: November 7, 2011 (DOI: 10.1002/acr.20607). http://doi.wiley.com/10.1002/acr.20607.

Author Contact: Media wishing to speak with Dr. Costenbader may contact Lori Shanks with Brigham and Women's Hospital at ljshanks@partners.org or at 617-534-1604.

About the Journal

Arthritis Care & Research is an official journal of the American College of Rheumatology (ACR), and the Association of Rheumatology Health Professionals (ARHP), a division of the College. Arthritis Care & Research is a peer-reviewed research publication that publishes both original research and review articles that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with arthritis and related disorders, major topics are evidence-based practice studies, clinical problems, practice guidelines, health care economics, health care policy, educational, social, and public health issues, and future trends in rheumatology practice. For details, please visit Arthritis Care & Research.

About Wiley-Blackwell

Wiley-Blackwell is the international scientific, technical, medical, and scholarly publishing business of John Wiley & Sons, with strengths in every major academic and professional field and partnerships with many of the world's leading societies. Wiley-Blackwell publishes nearly 1,500 peer-reviewed journals and 1,500+ new books annually in print and online, as well as databases, major reference works and laboratory protocols. For more information, please visit www.wileyblackwell.com or our new online platform, Wiley Online Library (wileyonlinelibrary.com), one of the world's most extensive multidisciplinary collections of online resources, covering life, health, social and physical sciences, and humanities.

Media Advisory

ACR Annual Meeting Press Registration Now Open

Press registration is now open to journalists planning to attend the 2011 ACR/ARHP Annual Scientific Meeting in Chicago. Held November 4-9, the ACR/ARHP Annual Scientific Meeting is the premier meeting in rheumatology.

For more information, including to view the press conference schedule, visit www.rheumatology.org/education/annual/newsroom.asp. Follow the meeting on twitter by using the official hashtag: #ACR2011.

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