Sabucedo Alberto J, Contreras Gabriel
Division of Nephrology, Division of Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL.
Division of Nephrology, Division of Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL.
Semin Nephrol. 2015 Sep;35(5):500-8. doi: 10.1016/j.semnephrol.2015.08.011.
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.
由系统性红斑狼疮导致的肾病占美国终末期肾病（ESKD）患者总数的1.9%。在美国，进展为ESKD的狼疮性肾炎（LN）系统性红斑狼疮患者大多为女性（81%）且具有非洲血统（49%），开始肾脏替代治疗（RRT）时的平均年龄为41岁。1982年至1998年间，LN患者的ESKD发病率稳步上升，原因是美国更愿意为LN患者提供RRT。然而，在21世纪初发病率似乎趋于平稳，最近有所下降，在2009年至2010年的两年期内，每百万患者年约有3.26例新发病例。当LN患者接近ESKD时，患者和医疗服务提供者必须在可用的RRT选项中做出选择。用于支持LN ESKD患者的RRT趋势并非受肾移植相比透析具有较低死亡率（分别在5年随访评估期间，生存率>85%对73%）的影响。不到4%的LN ESKD患者进行了抢先肾移植。尽管开始接受血液透析和腹膜透析的LN ESKD患者生存率相似（分别在3年随访评估期间为77%对79%），但在美国，超过80%的患者开始接受血液透析，不到15%的患者开始接受腹膜透析。
