Pediatric Nephrology

, Volume 26, Issue 1, pp 93–98

Increased risk of death in pediatric and adult patients with ESRD secondary to lupus

  • Sangeeta Sule
  • Barbara Fivush
  • Alicia Neu
  • Susan Furth
Original Article

Abstract

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that can cause significant kidney disease. Our goal was to assess the relative mortality risk associated with SLE in pediatric and adult populations with end-stage renal disease (ESRD) maintained on hemodialysis (HD). We performed Kaplan–Meier survival analysis from data collected by the United States Renal Data System (USRDS) in strata of pediatric and adult patients. This file includes data on all Medicare-reimbursed renal replacement patients. Cox proportional hazard models were used to assess mortality after adjusting for race and gender. Subjects were censored at transplantation or at end of follow-up. Pediatric patients with ESRD secondary to SLE had a 2-fold increased risk of death compared with other pediatric patients with ESRD (hazard ratio [HR]: 2.4, 95% confidence interval [CI]: 1.5–3.7). Adult patients with ESRD secondary to SLE were also at increased risk of death compared with other adult patients (HR: 1.7, 95% CI: 1.2–2.7). The most common causes of death in both pediatric and adult patients with SLE were cardiovascular disease and cardiac arrest. Our study demonstrates that there is a significant increase in mortality secondary to cardiovascular disease in pediatric and adult patients with ESRD secondary to SLE. Patients with ESRD secondary to SLE may need aggressive monitoring for traditional risk factors for atherosclerosis and the diagnosis of SLE alone may be an independent risk factor for death in patients with ESRD.

Keywords

Systemic lupus erythematosus Pediatrics Dialysis Mortality 

References

  1. 1.
    Stichweh D, Arce E, Pascual V (2004) Update on pediatric systemic lupus erythematosus. Curr Opin Rheumatol 16:577–587CrossRefPubMedGoogle Scholar
  2. 2.
    Jimenez S, Cervera R, Font J, Ingelmo M (2003) The epidemiology of systemic lupus erythematosus. Clin Rev Allergy Immunol 25:3–12CrossRefPubMedGoogle Scholar
  3. 3.
    Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK, Liang MH, Kremers HM, Mayes MD, Merkel PA, Pillemer SR, Reveille JD, Stone JH, Workgroup National Arthritis Data (2008) Estimates of the prevalence of arthritis and other rheumatic conditions in the united states. I. Arthritis Rheum 58:15–25CrossRefPubMedGoogle Scholar
  4. 4.
    Bogdanovic R, Nikolic V, Pasic S, Dimitrijevic J, Lipkovska-Markovic J, Eric-Marinkovic J, Ognjanovic M, Minic A, Stajic N (2004) Lupus nephritis in childhood: a review of 53 patients followed at a single center. Pediatr Nephrol 19:36–44CrossRefPubMedGoogle Scholar
  5. 5.
    Elliot V, Cairns T, Cook HT (2006) Evolution of lesions over 10 years in a patient with SLE: flowchart approach to the new International Society of Nephrology (ISN)/Renal Pathology Society (RPS) classification of lupus nephritis. Am J Kidney Dis 47:184–190CrossRefPubMedGoogle Scholar
  6. 6.
    Hagelberg S, Lee Y, Bargman J, Mah G, Schneider R, Laskin C, Eddy A, Gladman D, Urowitz M, Hebert D, Silverman E (2002) Longterm followup of childhood lupus nephritis. J Rheumatol 29:2635–2642PubMedGoogle Scholar
  7. 7.
    Rood MJ, ten Cate R, van Suijlekom-Smit LW, den Ouden EJ, Ouwerkerk FE, Breedveld FC, Huizinga TW (1999) Childhood-onset systemic lupus erythematosus: clinical presentation and prognosis in 31 patients. Scand J Rheumatol 28:222–226CrossRefPubMedGoogle Scholar
  8. 8.
    Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, Balow JE, Bruijn JA, Cook T, Ferrario F, Fogo AB, Ginzler EM, Hebert L, Hill G, Hill P, Jennette JC, Kong NC, Lesavre P, Lockshin M, Looi LM, Makino H, Moura LA, Nagata M, International Society of Nephrology Working Group on the Classification of Lupus Nephritis, Renal Pathology Society Working Group on the Classification of Lupus Nephritis (2004) The classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney Int 65:521–530CrossRefPubMedGoogle Scholar
  9. 9.
    US Renal Data System, USRDS 2004 Annual Data Report: Atlas of End-Stage Renal Disease in the United States (2004) National Institutes of Health, National Institute of Diabetes and Digestive and Kidney DiseasesGoogle Scholar
  10. 10.
    Bartosh SM, Fine RN, Sullivan EK (2001) Outcome after transplantation of young patients with systemic lupus erythematosus: a report of the North American Pediatric Renal Transplant Cooperative Study. Transplantation 72:973–978CrossRefPubMedGoogle Scholar
  11. 11.
    Manzi S, Meilahn EN, Rairie JE, Conte CG, Medsger TA Jr, Jansen-McWilliams L, D'Agostino RB, Kuller LH (1997) Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol 145:408–415PubMedGoogle Scholar
  12. 12.
    Van Doornum S, McColl G, Wicks IP (2002) Accelerated atherosclerosis: an extraarticular feature of rheumatoid arthritis? Arthritis Rheum 46:862–873CrossRefPubMedGoogle Scholar
  13. 13.
    Esdaile JM, Abrahamowicz M, Grodzicky T, Li Y, Panaritis C, du Berger R, Cote R, Grover SA, Fortin PR, Clarke AE, Senecal JL (2001) Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. Arthritis Rheum 44:2331–2337CrossRefPubMedGoogle Scholar
  14. 14.
    Gazarian M, Feldman BM, Benson LN, Gilday DL, Laxer RM, Silverman ED (1998) Assessment of myocardial perfusion and function in childhood systemic lupus erythematosus. J Pediatr 132:109–116CrossRefPubMedGoogle Scholar
  15. 15.
    Schanberg LE, Sandborg C, Barnhart HX, Ardoin SP, Yow E, Evans GW, Mieszkalski KL, Ilowite NT, Eberhard A, Levy DM, Kimura Y, von Scheven E, Silverman E, Bowyer SL, Punaro L, Singer NG, Sherry DD, McCurdy D, Klein-Gitelman M, Wallace C, Silver R, Wagner-Weiner L, Higgins GC, Brunner HI, Jung L, Soep JB, Reed A, Atherosclerosis Prevention in Pediatric Lupus Erythematosus Investigators (2009) Premature atherosclerosis in pediatric systemic lupus erythematosus: risk factors for increased carotid intima-media thickness in the Atherosclerosis Prevention in Pediatric Lupus Erythematosus Cohort. Arthritis Rheum 60:1496–1507CrossRefPubMedGoogle Scholar
  16. 16.
    Manzi S, Selzer F, Sutton-Tyrrell K, Fitzgerald SG, Rairie JE, Tracy RP, Kuller LH (1999) Prevalence and risk factors of carotid plaque in women with systemic lupus erythematosus. Arthritis Rheum 42:51–60CrossRefPubMedGoogle Scholar
  17. 17.
    Ridker PM, Hennekens CH, Buring JE, Rifai N (2000) C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med 342:836–843CrossRefPubMedGoogle Scholar
  18. 18.
    Wang TJ, Nam BH, Wilson PW, Wolf PA, Levy D, Polak JF, D'Agostino RB, O'Donnell CJ (2002) Association of C-reactive protein with carotid atherosclerosis in men and women: the Framingham Heart Study. Arterioscler Thromb Vasc Biol 22:1662–1667CrossRefPubMedGoogle Scholar
  19. 19.
    Mangge H, Hubmann H, Pilz S, Schauenstein K, Renner W, Marz W (2004) Beyond cholesterol–inflammatory cytokines, the key mediators in atherosclerosis. Clin Chem Lab Med 42:467–474CrossRefPubMedGoogle Scholar
  20. 20.
    Ridker PM, Rifai N, Pfeffer M, Sacks F, Lepage S, Braunwald E (2000) Elevation of tumor necrosis factor-alpha and increased risk of recurrent coronary events after myocardial infarction. Circulation 101:2149–2153PubMedGoogle Scholar
  21. 21.
    Roman MJ, Shanker BA, Davis A, Lockshin MD, Sammaritano L, Simantov R, Crow MK, Schwartz JE, Paget SA, Devereux RB, Salmon JE (2003) Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus. N Engl J Med 349:2399–2406CrossRefPubMedGoogle Scholar
  22. 22.
    Asanuma Y, Oeser A, Shintani AK, Turner E, Olsen N, Fazio S, Linton MF, Raggi P, Stein CM (2003) Premature coronary-artery atherosclerosis in systemic lupus erythematosus. N Engl J Med 349:2407–2415CrossRefPubMedGoogle Scholar
  23. 23.
    Petri M, Perez-Gutthann S, Spence D, Hochberg MC (1992) Risk factors for coronary artery disease in patients with systemic lupus erythematosus. Am J Med 93:513–519CrossRefPubMedGoogle Scholar
  24. 24.
    Ilowite NT, Samuel P, Ginzler E, Jacobson MS (1988) Dyslipoproteinemia in pediatric systemic lupus erythematosus. Arthritis Rheum 31:859–863CrossRefPubMedGoogle Scholar
  25. 25.
    Frostegard J (2002) Autoimmunity, oxidized LDL and cardiovascular disease. Autoimmun Rev 1:233–237CrossRefPubMedGoogle Scholar
  26. 26.
    Posadas-Romero C, Torres-Tamayo M, Zamora-Gonzalez J, Aguilar-Herrera BE, Posadas-Sanchez R, Cardoso-Saldana G, Ladron de Guevara G, Solis-Vallejo E, El Hafidi M (2004) High insulin levels and increased low-density lipoprotein oxidizability in pediatric patients with systemic lupus erythematosus. Arthritis Rheum 50:160–165CrossRefPubMedGoogle Scholar
  27. 27.
    Parekh RS, Zhang L, Fivush BA, Klag MJ (2005) Incidence of atherosclerosis by race in the dialysis morbidity and mortality study: a sample of the US ESRD population. J Am Soc Nephrol 16:1420–1426CrossRefPubMedGoogle Scholar
  28. 28.
    Parekh RS, Plantinga LC, Kao WH, Meoni LA, Jaar BG, Fink NE, Powe NR, Coresh J, Klag MJ (2008) The association of sudden cardiac death with inflammation and other traditional risk factors. Kidney Int 74:1335–1342CrossRefPubMedGoogle Scholar
  29. 29.
    Fong KY, Thumboo J, Koh ET, Chng HH, Leong KH, Koh WH, Howe HS, Leong KP, Lim B, Koh DR, Ng SC, Feng PH, Boey ML (1997) Systemic lupus erythematosus: initial manifestations and clinical features after 10 years of disease. Ann Acad Med Singapore 26:278–281PubMedGoogle Scholar
  30. 30.
    Elliott JR, Manzi S (2009) Cardiovascular risk assessment and treatment in systemic lupus erythematosus. Best Pract Res Clin Rheumatol 23:481–494CrossRefPubMedGoogle Scholar
  31. 31.
    Falaschi F, Ravelli A, Martignoni A, Migliavacca D, Sartori M, Pistorio A, Perani G, Martini A (2000) Nephrotic-range proteinuria, the major risk factor for early atherosclerosis in juvenile-onset systemic lupus erythematosus. Arthritis Rheum 43:1405–1409CrossRefPubMedGoogle Scholar

Copyright information

© IPNA 2010

Authors and Affiliations

  • Sangeeta Sule
    • 1
  • Barbara Fivush
    • 1
  • Alicia Neu
    • 1
  • Susan Furth
    • 2
  1. 1.Johns Hopkins UniversityBaltimoreUSA
  2. 2.Children’s Hospital of PhiladelphiaPhiladelphiaUSA

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