End‐stage renal disease due to lupus nephritis among children in the US, 1995–2006

Objective To identify predictors of wait‐listing for kidney transplantation, kidney transplantation, and mortality among children with lupus nephritis–associated end‐stage renal disease (ESRD). Methods Children ages 5–18 years with new‐onset lupus nephritis–associated ESRD were identified in the US Renal Data System (1995–2006). Demographic and clinical characteristics, causes of death, and predictors of wait‐listing for kidney transplantation, kidney transplantation, and mortality during the first 5 years of ESRD were investigated. Cox proportional hazards models were used. Results A total of 583 children had incident lupus nephritis–associated ESRD. The mean ± SD age of the patients at the time of ESRD onset was 16.2 ± 2.4 years; 49% were African American, and 24% were Hispanic. During the 5‐year period after the onset of ESRD, 292 (49%) were wait‐listed, 193 (33%) received a kidney transplant, and 131 (22%) died. The main causes of death were cardiopulmonary (31%) and infectious (16%). Children living in the northeast and west were more than twice as likely as children in the south to be wait‐listed and were >50% more likely than children in the south to undergo transplantation. There were fewer kidney transplants among older versus younger patients (odds ratio [OR] 0.59, P = 0.009), African American versus white patients (OR 0.48, P < 0.001), Hispanic versus non‐Hispanic patients (OR 0.63, P = 0.03), and those with Medicaid versus those with private insurance (OR 0.70, P = 0.03). Mortality among African American children was almost double that among white children (OR 1.83, P < 0.001). Conclusion Among US children with lupus nephritis–associated ESRD, age, race, ethnicity, type of medical insurance, and geographic region were associated with significant variation in 5‐year wait‐listing for kidney transplantation, kidney transplantation, and mortality.