American Journal of Kidney Diseases

Dialysis Outcomes for Children With Lupus Nephritis Compared to Children With Other Forms of Nephritis: A Retrospective Cohort Study

Published:August 27, 2021DOI:

      Rationale & Objective

      Children with lupus nephritis (LN) are at high risk of developing kidney failure requiring initiation of kidney replacement therapy. This study compared outcomes among children with LN on dialysis with children with non-lupus glomerular disease and investigated risk factors for adverse outcomes among children with LN on dialysis.

      Study Design

      Retrospective cohort study.

      Setting & Participants

      Children and adolescents aged 6-20 years with LN (n = 231) and non-lupus glomerular disease (n = 1,726) who initiated maintenance dialysis 1991-2018 and were enrolled in the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) registry.


      Lupus nephritis.


      Hospitalization, mortality, and time to transplant.

      Analytical Approach

      Contingency tables were used to compare hospitalizations, and multivariable cause-specific hazards models were used to compare rates of death and transplantation in children with LN compared with those with non-lupus glomerular disease. Using data from children with LN, multivariable logistic regression models were fit to evaluate the risk factors for hospitalization, and multivariable Cox regression models were fit to evaluate factors associated with kidney transplantation.


      Children with LN were more likely to be hospitalized in the first year after dialysis initiation (63.3% vs 48.6%, P < 0.001) and were less likely to receive a kidney transplant in the first 3 years after dialysis initiation (year 0-1: adjusted hazard ratio [AHR], 0.36 [95% CI, 0.23-0.57], P < 0.001; year 1-3: AHR, 0.73 [95% CI, 0.54-0.98], P = 0.04). Anemia was associated with hospitalization after dialysis initiation (adjusted OR, 4.44 [95% CI, 1.44-13.66], P = 0.01). Non-White race was associated with a lower rate of kidney transplantation (AHR, 0.47 [95% CI, 0.27-0.82], P = 0.01). LN was not associated with death while on dialysis (AHR, 1.21 [95% CI, 0.47-3.11], P = 0.7).


      The NAPRTCS registry does not collect information on lupus disease activity or medication doses and has limited data on medication use.


      Children and adolescents with LN on dialysis are at higher risk for adverse outcomes including hospitalization and lower rates of kidney transplantation compared with children with non-lupus glomerular disease receiving maintenance dialysis.

      Index Words

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      Linked Article

      • Kidney Failure in Systemic Lupus Erythematosus: A Fraught Complication in a Fraught Disease
        American Journal of Kidney DiseasesVol. 79Issue 5
        • Preview
          Lupus nephritis (LN) is the most common serious organ manifestation of systemic lupus erythematosus (SLE), and significantly increases the morbidity and mortality of the patients in whom it develops.1 An intense effort by lupus patients, clinician-scientists, and the pharmaceutical industry has resulted in the approval of 2 new therapies for LN, with more on the way, leading to a sense of elation in the lupus community. However, the reality for patients who have already developed kidney failure from LN is not as optimistic.
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