Sexton Donal J, Reule Scott, Solid Craig, Chen Shu-Cheng, Collins Allan J, Foley Robert N
Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota, and Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota, and.
Clin J Am Soc Nephrol. 2015 Feb 6;10(2):251-9. doi: 10.2215/CJN.02350314. Epub 2014 Dec 22.
While ESRD from lupus nephritis (ESLN) increased in the United States after the mid-1990s and racial disparities were apparent, current trends are unknown.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Retrospective US Renal Data System data (n=1,557,117) were used to calculate standardized incidence ratios (standardized to 1995-1996) and outcomes of ESLN (n=16,649). For events occurring after initiation of RRT, follow-up ended on June 30, 2011.
Overall ESLN rates (95% confidence intervals [95% CIs]) in 1995-1996 were 3.1 (2.9 to 3.2) cases per million per year. Rates were higher for subgroups characterized by African-American race (11.1 [95% CI, 10.3 to 11.9]); other race (4.9 [95% CI, 4.0 to 5.8]); female sex (4.9 [95% CI, 4.6 to 5.2]); and ages 20-29 years (4.9 [95% CI, 4.4 to 5.4]), 30-44 years (4.6 [95% CI, 4.2 to 5.0]), and 45-64 years (4.0 [95% CI, 3.7 to 4.4]). Standardized incidence ratios for the overall population in subsequent biennia were 1.19 (1.14 to 1.24) in 1997-1998, 1.17 (1.12 to 1.22) in 1999-2000, 1.17 (1.12 to 1.22) in 2001-2002, 1.21 (1.16 to 1.26) in 2003-2004, 1.18 (1.13 to 1.23) in 2005-2006, 1.16 (1.11 to 1.21) in 2007-2008, and 1.05 (1.01 to 1.09) in 2009-2010, respectively. During a median (interquartile range) follow-up of 4.4 (6.3) years, 42.6% of patients with ESLN died, 45.3% were listed for renal transplant, and 28.7% underwent transplantation. Patients with ESLN were more likely than matched controls to be listed for and to undergo transplantation, and mortality rates were similar. Among patients with ESLN, African Americans were less likely to undergo transplantation (adjusted hazard ratio, 0.54 [0.51 to 0.58]) and more likely to die prematurely (adjusted hazard ratio, 1.23 [1.17 to 1.30]).
While ESLN appears to have stopped increasing in the last decade, racial disparities in outcomes persist.
20世纪90年代中期以后，美国狼疮性肾炎所致终末期肾病（ESLN）的发病率有所上升，种族差异明显，但目前的趋势尚不清楚。
设计、研究地点、参与者及测量指标：利用美国肾脏数据系统的回顾性数据（n = 1,557,117）计算标准化发病率（以1995 - 1996年为标准）及ESLN的转归情况（n = 16,649）。对于开始肾脏替代治疗（RRT）后发生的事件，随访截至2011年6月30日。
1995 - 1996年ESLN的总体发病率（95%置信区间[95%CI]）为每年每百万人口3.1例（2.9至3.2例）。以非裔美国人种族（11.1[95%CI，10.3至11.9]）、其他种族（4.9[95%CI，4.0至5.8]）、女性（4.9[95%CI，4.6至5.2]）以及年龄20 - 29岁（4.9[95%CI，4.4至5.4]）、30 - 44岁（4.6[95%CI，4.2至5.0]）和45 - 64岁（4.0[95%CI，3.7至4.4]）为特征的亚组发病率较高。随后各两年期总体人群的标准化发病率分别为：1997 - 1998年1.19（1.14至1.24）、1999 - 2000年1.17（1.12至1.22）、2001 - 2002年1.17（1.12至1.22）、2003 - 2004年1.21（1.16至1.26）、2005 - 2006年1.18（1.13至1.23）、2007 - 2008年1.16（1.11至1.21）以及2009 - 2010年1.05（1.01至1.09）。在中位（四分位间距）随访4.4（6.3）年期间，42.6%的ESLN患者死亡，45.3%被列入肾脏移植名单，28.7%接受了移植。与匹配的对照组相比，ESLN患者被列入移植名单并接受移植的可能性更大，死亡率相似。在ESLN患者中，非裔美国人接受移植的可能性较小（调整后风险比，0.54[0.51至0.58]），过早死亡的可能性更大（调整后风险比，1.23[1.17至1.30]）。
虽然ESLN在过去十年似乎已停止上升，但转归方面的种族差异仍然存在。
