Costenbader Karen H, Desai Amrita, Alarcón Graciela S, Hiraki Linda T, Shaykevich Tamara, Brookhart M Alan, Massarotti Elena, Lu Bing, Solomon Daniel H, Winkelmayer Wolfgang C
Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
Arthritis Rheum. 2011 Jun;63(6):1681-8. doi: 10.1002/art.30293.
This study was undertaken to investigate whether recent advances in lupus nephritis treatment have led to changes in the incidence of end-stage renal disease (ESRD) secondary to lupus nephritis, or in the characteristics, treatments, and outcomes of patients with lupus nephritis ESRD.
Patients with incident lupus nephritis ESRD (1995-2006) were identified in the US Renal Data System. Trends in sociodemographic and clinical characteristics were assessed. We tested for temporal changes in standardized incidence rates (SIRs) for sociodemographic groups using Poisson regression. Changes in rates of waitlisting for kidney transplant, kidney transplantation, and all-cause mortality were examined using crude and adjusted time-to-event analyses.
We identified 12,344 incident cases of lupus nephritis ESRD. Mean age at ESRD onset was 41 years; 81.6% of the patients were women and 49.5% were African American. SIRs for lupus nephritis ESRD among those who were ages 5-39 years, African American, or lived in the southeastern US increased significantly from 1995 to 2006. Increases in body mass index and in the prevalence of both diabetes mellitus and hypertension were detected. Mean serum hemoglobin level at ESRD onset increased, while that of serum creatinine decreased over time. More patients received hemodialysis and fewer received peritoneal dialysis. There was a slight increase in the frequency of preemptive kidney transplantation at ESRD onset, but kidney transplantation rates within the first 3 years of ESRD declined. Mortality did not change over the 12 years of study.
Our findings indicate that the characteristics of patients with lupus nephritis ESRD and initial therapies have changed in recent years. While SIRs rose in younger patients, among African Americans, and in the South, outcomes did not improve in over a decade of evaluation.
本研究旨在调查狼疮性肾炎治疗的近期进展是否导致狼疮性肾炎继发终末期肾病（ESRD）的发病率发生变化，或狼疮性肾炎ESRD患者的特征、治疗方法及预后发生变化。
在美国肾脏数据系统中识别出初发狼疮性肾炎ESRD患者（1995 - 2006年）。评估社会人口统计学和临床特征的趋势。我们使用泊松回归测试社会人口统计学组标准化发病率（SIRs）的时间变化。使用粗事件时间分析和校正事件时间分析检查肾移植等待名单率、肾移植率和全因死亡率的变化。
我们识别出12344例初发狼疮性肾炎ESRD病例。ESRD发病的平均年龄为41岁；81.6%的患者为女性，49.5%为非裔美国人。1995年至2006年期间，5至39岁、非裔美国人或居住在美国东南部的人群中狼疮性肾炎ESRD的SIRs显著增加。检测到体重指数、糖尿病和高血压患病率增加。ESRD发病时的平均血清血红蛋白水平升高，而血清肌酐水平随时间下降。更多患者接受血液透析，接受腹膜透析的患者减少。ESRD发病时抢先肾移植的频率略有增加，但ESRD前3年内的肾移植率下降。在12年的研究期间死亡率没有变化。
我们的研究结果表明，近年来狼疮性肾炎ESRD患者的特征和初始治疗方法发生了变化。虽然年轻患者、非裔美国人和南方人群的SIRs有所上升，但在十多年的评估中预后并未改善。
