Incidence of Kidney Replacement Therapy and Subsequent Outcomes Among Patients With Systemic Lupus Erythematosus: Findings From the ERA Registry

Ondrej Derner, Anneke Kramer*, Zdenka Hruskova, Mustafa Arici, Frederic Collart, Patrik Finne, Laura Fuentes Sánchez, Jérôme Harambat, Marc H. Hemmelder, Kristine Hommel, Julia Kerschbaum, Johan De Meester, Runolfur Palsson, Mårten Segelmark, Rannveig Skrunes, Jamie P. Traynor, Oscar Zurriaga, Ziad A. Massy, Kitty J. Jager, Vianda S. StelVladimir Tesar

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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RATIONALE & OBJECTIVE: There is a dearth of data characterizing patients receiving kidney replacement therapy (KRT) for kidney failure due to systemic lupus erythematosus (SLE) and their clinical outcomes. The aim of this study was to describe trends in incidence and prevalence of KRT among these patients as well as to compare their outcomes versus those of patients treated with KRT for diseases other than SLE.

STUDY DESIGN: Retrospective cohort study based on kidney registry data.

SETTING & PARTICIPANTS: Patients recorded in 14 registries of patients receiving KRT that provided data to the European Renal Association Registry between 1992 and 2016.

PREDICTOR: SLE as cause of kidney failure.

OUTCOMES: Incidence and prevalence of KRT, patient survival while receiving KRT, patient and graft survival after kidney transplant, and specific causes of death.

ANALYTICAL APPROACH: Kaplan-Meier methods and Cox regression models were fit to compare patient survival between the SLE and non-SLE groups, overall KRT, dialysis, and patient and graft survival after kidney transplant.

RESULTS: In total, 1,826 patients commenced KRT for kidney failure due to SLE, representing an incidence of 0.80 per million population (pmp) per year. The incidence remained stable during the study period (annual percent change, 0.1% [95% CI, -0.6% to 0.8%]). Patient survival among patients with SLE receiving KRT was similar to survival in the comparator group (hazard ratio [HR], 1.11 [95% CI, 0.99-1.23]). After kidney transplant, the risk of death was greater among patients with SLE than among patients in the comparator group (HR, 1.25 [95% CI, 1.02-1.53]), whereas the risk of all-cause graft failure was similar (HR, 1.09 [95% CI, 0.95-1.27]). Ten-year patient overall survival during KRT and patient and graft survival after kidney transplant improved over the study period (HRs of 0.71 [95% CI, 0.56-0.91], 0.43 [95% CI, 0.27-0.69], and 0.60 [95% CI, 0.43-0.84], respectively). Patients with SLE receiving KRT were significantly more likely to die of infections (24.8%) than patients in the comparator group (16.9%; P < 0.001).

LIMITATIONS: No data were available on extrarenal manifestations of SLE, drug treatments, comorbidities, kidney transplant characteristics, or relapses of SLE.

CONCLUSIONS: The prognosis of patients with SLE receiving KRT has improved over time. Survival of patients with SLE who required KRT was similar compared with patients who required KRT for other causes of kidney failure. Survival following kidney transplants was worse among patients with SLE.

Original languageEnglish
Pages (from-to)635-645
Number of pages11
JournalAmerican Journal of Kidney Diseases
Issue number5
Publication statusPublished - May 2022

Bibliographical note

Funding Information:
Dr Derner received financial support from Charles University’s PROGRES Q25/LF1 program to cover travel expenses.

Funding Information:
Ondrej Derner, MD, Anneke Kramer, PhD, Zdenka Hruskova, MD, Mustafa Arici, MD, Frederic Collart, MD, Patrik Finne, MD, PhD, Laura Fuentes S?nchez, MD, J?r?me Harambat, MD, PhD, Marc H. Hemmelder, MD, Kristine Hommel, MD, Julia Kerschbaum, MD, MSc, MPH, Johan De Meester, MD, PhD, Runolfur Palsson, MD, M?rten Segelmark, MD, Rannveig Skrunes, MD, Jamie P. Traynor, MD, Oscar Zurriaga, MD, PhD, Ziad A. Massy, MD, PhD, Kitty J. Jager, MD, PhD, Vianda S. Stel, PhD, and Vladimir Tesar, MD, PhD. This article was written on behalf of the ERA Registry, which is an official body of the ERA (European Renal Association). Research idea and study design: OD, ZH, VT, KJJ, VSS, AK; data acquisition: MA, FC, PF, LFS, JH, MHH, KH, JK, JDM, RP, MS, RS, JPT, OZ, ZAM; data analysis/interpretation: OD, AK, KJJ, VSS, VT, ZH; supervision or mentorship: VT, KJJ. Each author contributed important intellectual content during manuscript drafting or revision and agrees to be personally accountable for the individual's own contributions and to ensure that questions pertaining to the accuracy or integrity of any portion of the work, even one in which the author was not directly involved, are appropriately investigated and resolved, including with documentation in the literature if appropriate. Dr Derner received financial support from Charles University's PROGRES Q25/LF1 program to cover travel expenses. The authors declare that they have no relevant financial interests. We would like to thank the patients and the staff of the dialysis and transplant units for contributing the data via their national and regional kidney registries. Furthermore, we gratefully acknowledge the following registries and persons for their contribution of the data: Austrian Dialysis and Transplant Registry (OEDTR; R. Kramar); French-speaking Belgian Society of Nephrology (GNFB; J-M. des Grottes); Danish Nephrology Registry (DNS; J.G. Heaf); Finnish Registry for Kidney Diseases (J. Helve and P.H. Groop); Hellenic Renal Registry (G. Moustakas); Icelandic End-Stage Renal Disease Registry; Norwegian Renal Registry (A.V. Reis?ter, and A. ?sberg); Swedish Renal Registry (SRR; K.G. Pr?tz, M. Stendahl, M. Evans, H. Rydell, and T. Lundgren); Dutch Renal Registry (RENINE); Scottish Renal Registry (SRR; all of the Scottish renal units); and the regional registries of Andalusia (SICATA; P. Castro de la Nuez, on behalf of all users of SICATA): Basque country (UNIPAR; ?. Magaz, J. Aranzabal, M. Rodrigo, and I. Moina), Catalonia (RMRC; J. Comas), and Valencian region (REMRENAL; N. Fuster Camarena and J. P?rez Penad?s); the other ERA Registry committee members not mentioned above for their advice in the analysis and the drafting of this paper: C. Zoccali, L. Mercadal, S.S. S?rensen, and E. Vidal; and the AMC Registry office for data collection and management. The ERA Registry is funded by the ERA. Received November 24, 2020. Evaluated by 3 external peer reviewers, with direct editorial input from a Statistics/Methods Editor, an Associate Editor, and the Editor-in-Chief. Accepted in revised form September 18, 2021.

Publisher Copyright:
© 2021 The Authors

Other keywords

  • end-stage renal disease (ESRD)
  • Europe
  • incidence
  • kidney disease
  • kidney failure
  • kidney replacement therapy (KRT)
  • kidney transplantation
  • lupus nephritis (LN)
  • prevalence
  • prognosis
  • registry study
  • survival
  • Systemic lupus erythematosus (SLE)
  • Humans
  • Male
  • Kidney Failure, Chronic/epidemiology
  • Incidence
  • Lupus Erythematosus, Systemic/complications
  • Renal Insufficiency/complications
  • Lupus Nephritis
  • Female
  • Registries
  • Renal Replacement Therapy/methods
  • Retrospective Studies


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