Kidney Transplantation and Cardiovascular Events Among Patients With End-Stage Renal Disease Due to Lupus Nephritis: A Nationwide Cohort Study.
Kidney Transplantation and Cardiovascular Events Among Patients With End-Stage Renal Disease Due to Lupus Nephritis: A Nationwide Cohort Study.
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DOI：
10.1002/acr.24725
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发表时间：
2022-11
影响因子：
4.7
通讯作者：
Wallace ZS
中科院分区：
文献类型：
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作者：
Jorge A;Fu X;Cook C;Lu N;Zhang Y;Choi HK;Wallace ZS
我们试图评估肾移植对狼疮性肾炎（LN）所致终末期肾病（ESRD）患者心血管（CV）事件的潜在影响。在一项全国性队列研究中，我们确定了在2000年1月至2016年12月期间在美国肾脏数据系统中登记的所有LN-ESRD患者，这些患者在等待肾移植并在医疗保险中登记。主要结局为心血管事件，包括心肌梗死（MI）和缺血性脑血管意外（CVA）。我们使用时间依赖性考克斯回归来估计这些与肾移植相关的结局的风险比（HR），作为随时间变化的暴露，调整性别、年龄、人种、种族、地理区域、ESRD发作年份、首次ESRD治疗方式（例如，血液透析或腹膜透析）、Charlson合并症评分和既往器官移植史。在5，963名LN-ESRD患者中，3，209名（54%）在研究期间接受了肾移植。大多数是女性（82%），非洲裔美国人占等待患者的48%和移植患者的43%。肾移植与CV事件发生风险较低（调整后HR 0.31 [95%CI 0.18-0.53]）以及MI和CVA风险较低（调整后HR分别为0.13 [95%CI 0.08-0.34]和0.30 [95%CI 0.16-0.54]）相关。在LN-ESRD患者中，肾移植与CV事件（包括MI和CVA）风险降低相关。我们的研究结果强调了在这一人群中识别移植障碍的重要性，因为改善可及性可以降低CV发病率。
We sought to assess the potential impact of kidney transplantation on cardiovascular (CV) events among patients with end-stage renal disease (ESRD) due to lupus nephritis (LN). In a nationwide cohort study, we identified all patients with LN-ESRD enrolled in the United States Renal Data System who were waitlisted for a kidney transplant and enrolled in Medicare between January, 2000 and December, 2016. The primary outcome was incident CV events, including myocardial infarctions (MI) and ischemic cerebrovascular accidents (CVA). We used time-dependent Cox regression to estimate the hazard ratios (HRs) of these outcomes associated with kidney transplant as a time-varying exposure, adjusting for sex, age, race, ethnicity, geographic region, year of ESRD onset, first ESRD treatment modality (e.g., hemodialysis or peritoneal dialysis), Charlson comorbidity score, and history of prior organ transplants. Of 5,963 waitlisted patients with LN-ESRD, 3,209 (54%) had a kidney transplant during the study period. The majority were female (82%), and African Americans represented 48% of waitlisted patients and 43% of transplanted patients. Kidney transplantation was associated with a lower risk of incident CV events (adjusted HR 0.31 [95% CI 0.18–0.53]) as well as lower risks of MI and CVA (adjusted HRs 0.13 [95% CI 0.08–0.34] and 0.30 [95% CI 0.16–0.54], respectively). Kidney transplantation was associated with a reduced risk of CV events, including MI and CVA, in patients with LN-ESRD. Our findings highlight the importance of identifying barriers to transplantation in this population, as improved access could reduce CV morbidity.