Methodological considerations in comparing access to Pre-emptive renal transplantation between SLE and other ESRD causes in the USRDS

Anna Broder, Wenzhu B. Mowrey, Ladan Golestaneh, Chaim Putterman, Karen H. Costenbader, Mimi Kim

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: We compared pre-emptive transplant rates between SLE and non-SLE end-stage renal disease (ESRD) from the U.S. Renal Data System (USRDS) and investigated the potential influence of frequency matching and primary ESRD causes in the non-SLE group. Methods: 4830 adult SLE patients with incident ESRD from USRDS 2005–2009 were frequency matched by age, sex and race to 4830 patients with incident non-SLE ESRD. Multivariable logistic regression models were used to estimate the odds of pre-emptive transplantation in SLE and non-SLE, and with the non-SLE subgroups by primary ESRD cause. Results: The odds ratios (OR) of receiving a pre-emptive transplant were similar among non-SLE and SLE (referent group): OR = 1.18 (95% CI: 0.92, 1.50; p = 0.20). However, the ORs for receiving a pre-emptive transplant were 0.19 (95% CI: 0.08, 0.42) in type 2 diabetes ESRD, 0.42 (95% CI: 0.23, 0.75) for hypertension-associated ESRD, 1.67 (95% CI: 1.10, 2.54) in type 1 diabetes ESRD, and 2.06 (95% CI: 1.55, 2.73) for “other” ESRD. In contrast to non-SLE, younger SLE patients were less likely to receive a pre-emptive transplant than older SLE patients. Conclusion: The results of this study provide compelling evidence that major improvements need to be made in optimizing access to pre-emptive transplantation in SLE by addressing sociodemographic disparities and the unique challenges faced by SLE patients. Applying careful matching and selecting appropriate comparison groups in future studies may facilitate the development of effective strategies to address these barriers and to increase the number of pre-emptive renal transplants among SLE patients.

Original languageEnglish
Pages (from-to)678-685
Number of pages8
JournalSeminars in Arthritis and Rheumatism
Volume48
Issue number4
DOIs
StatePublished - Feb 2019
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2018 Elsevier Inc.

Funding

Rheumatology Research Foundation K Bridge Award and NIH/NIAMS K23 AR068441 (A Broder), NIH/NIAMS R01 AR 057327 and K24 AR 066109 (KH Costenbader).

FundersFunder number
NIH/NIAMSK23 AR068441, R01 AR 057327, K24 AR 066109
National Center for Advancing Translational SciencesUL1TR002556

    Keywords

    • Diabetes mallitus
    • End-stage renal disease
    • Lupus nephritis
    • Renal transplantation
    • Systemic lupus erythematosus

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