13th Congress of the Asian Society of Transplantation: Advances in Kidney Transplantation
Kidney Transplantation
Outcome of Lupus Nephritis After Entering Into End-Stage Renal Disease and Comparison Between Different Treatment Modalities: A Nationwide Population-Based Cohort Study in Taiwan

https://doi.org/10.1016/j.transproceed.2013.11.080Get rights and content

Abstract

Background

Systemic lupus erythematosus (SLE) is not a rare disease among the Chinese and the incidence is higher in the female population. Lupus nephritis (LN) often develops in patients with SLE and may progress to end-stage renal disease (ESRD). Although there are studies that suggest postponement of the scheduling of kidney transplantation (KT) for these patients, there are still some other studies with conflicting results. Our study aimed to analyze the outcome of patients with LN after progression to ESRD and to try to elucidate whether deferral of KT is necessary in the Chinese population.

Methods

We used the National Health Insurance Research Database to perform this cohort study. The study cohort was observed between 1998 and 2009 after being diagnosed as having SLE. The cases of SLE and ESRD were identified according to the catastrophic illness database.

Results

In total, 1998 SLE patients with ESRD were identified. They received hemodialysis, peritoneal dialysis, or KT with the proportion of 82.1%, 9.8%, and 8.1%, respectively. The 1-year, 5-year, 10-year patient survival rates were best for those who underwent KT (100%, 98.1%, and 94.4%, respectively), followed by peritoneal dialysis (88.3%, 79.1%, and 76%, respectively), and hemodialysis (53.6%, 46.0%, and 41.6%, respectively). For those who underwent KT within 1 year after ESRD, no significant worse patient survival and graft survival were observed than those who underwent KT 1 year later.

Conclusion

KT provides a better survival benefit for SLE patients with ESRD than hemodialysis and peritoneal dialysis. No obvious clinical benefit of KT deferral was observed in our study and the deferral may not be necessary for our population.

Section snippets

Materials and Methods

This study obtained data from the catastrophic illness registration of the Taiwan National Health Insurance Research Database (NHIRD). The nationwide cohort includes data from all SLE patients in Taiwan's NHIRD. The NHIRD has been described in many studies [3]. This social health insurance system started in 1995 and covered more than 23 million residents by 2010. Representing approximately 99% of Taiwan's population, this study includes all patients with SLE from 1998 to 2009. The diagnosis in

Results

In total, 1998 SLE patients with ESRD were identified (Table 1). The mean age was 38.3 ± 16.0 years; 84.3% was female. The incidences of hypertension, diabetes mellitus, hyperlipidemia, cardiovascular disease, chronic liver disease, and cancer were 63.1%, 10.1%, 20.7%, 13%, 12.4%, and 2.5%, respectively. They received hemodialysis, peritoneal dialysis, or KT with the proportion of 82.1%, 9.8%, and 8.1%, respectively. In the KT group, the pretransplantation duration was 4.4 ± 3.1 years. The mean

Discussion

Costenbader et al reported that more lupus patients received hemodialysis and fewer received peritoneal dialysis [4]. The frequency of pre-emptive KT at ESRD onset increased slightly. Overall mortality rates did not change during the 12 years in the United States. A poor prognosis of ESRD in SLE patients had been reported from the southern part of Taiwan about 10 years ago [2]. Patients have been considered to receive peritoneal dialysis or kidney donation only when they were clinically stable

References (7)

  • J.H. Stone

    End-stage renal disease in lupus: disease activity, dialysis, and the outcome of transplantation

    Lupus

    (1998)
  • P.T. Lee et al.

    Poor prognosis of end-stage renal disease in systemic lupus erythematosus: a cohort of Chinese patients

    Lupus

    (2003)
  • P.H. Wu et al.

    Predicting mortality of incident dialysis patients in Taiwan - a longitudinal population-based study

    PLoS One

    (2013)
There are more references available in the full text version of this article.

Cited by (18)

  • Long-term outcomes in lupus patients receiving different renal replacement therapy

    2019, Journal of Microbiology, Immunology and Infection
    Citation Excerpt :

    Reviewing the literature, patient and graft survival after kidney transplantation in patients with ESRD caused by lupus nephritis have been studied extensively and shown to be similar to those in matched non-lupus patients.7–10 However, studies comparing the clinical outcomes of lupus recipients of dialysis with that of lupus recipients of kidney transplants were limited.1,30 The aim of these studies was to analyze survival rate or disease activity after three renal replacement therapies, but not other adverse events.

  • Kidney Transplant Recipients With Rheumatic Diseases: Epidemiological Data From the Polish Transplant Registries 1998–2015

    2018, Transplantation Proceedings
    Citation Excerpt :

    However, a large meta-analysis by Tektonidou et al [5] indicates that improvement in LN outcomes plateaued in the mid-1990s with the risk of developing LN-related ESRD at 5, 10, and 15 years remaining at 11%, 17%, and 22%, respectively. Kidney transplantation provides a better survival benefit for SLE patients with ESRD than dialysis therapy [6]. The incidence of LN-related ESRD in the latest USRDS Annual Data Report is markedly lower than observed in Poltransplant cohort (1.92%).

View all citing articles on Scopus
View full text