ESKD, Transplantation, and Dialysis in Lupus Nephritis

Summary Kidney disease resulting from systemic lupus erythematosus accounts for 1.9% of the end-stage kidney disease (ESKD) population in the United States. Systemic lupus erythematosus patients with lupus nephritis (LN) who progress to ESKD in the United States are mostly female (81%) and of African ancestry (49%), with a mean age of 41 years at initiation of renal replacement therapy (RRT). The incidence of ESKD in patients with LN steadily increased between 1982 and 1998 because RRT was offered more readily to LN patients in the United States. However, it appears to have plateaued in the early 2000s, and recently decreased, with approximately 3.26 incident cases per million patient-years during the biennium period of 2009 to 2010. When LN patients approach ESKD, patients and providers must choose among the RRT options available. The trend of the RRT used to support LN ESKD patients is not guided by the lower mortality seen with the use of kidney transplantation compared with dialysis (>85% versus 73% survival during 5 years of follow-up evaluation, respectively). Less than 4% of LN ESKD patients have pre-emptive kidney transplantation. Although the survival of LN ESKD patients who begin with hemodialysis and peritoneal dialysis are similar (77% versus 79% during 3 years of follow-up evaluation, respectively), more than 80% of patients begin with hemodialysis and less than 15% begin with peritoneal dialysis in the United States.