Disparities in renal replacement in lupus nephritis: current practice and future implications.
Disparities in renal replacement in lupus nephritis: current practice and future implications.
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狼疮性肾炎肾脏替代的差异：当前实践和未来影响。
DOI：
10.1002/acr.20611
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发表时间：
2011
影响因子：
4.7
通讯作者：
Weisman,MichaelH
中科院分区：
文献类型：
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作者：
Ishimori,MarikoL;Gudsoorkar,Vineet;Venuturupalli,SwamyR;Weisman,MichaelH
众所周知，系统性红斑狼疮（SLE）患者存在健康差异。据报道，在美国，非裔美国人、亚洲人和西班牙裔美国人的SLE发病率和患病率高于欧裔美国人（1-3）。非裔美国人和西班牙裔妇女的发病率和患病率的中位年龄较低沿着社会经济地位较低（2-4）。在疾病结局方面也报告了显著的种族差异，在LUpus中，非裔美国人和得克萨斯州西班牙裔的损害和疾病严重程度高于白人和波多黎各西班牙裔，NATURE与养育队列沿着不同的遗传关联（4）。在SLE的多种表现中，狼疮性肾炎（LN）的发生预示着生存率低，在美国的非洲裔美国人、西班牙裔和亚洲患者中更为常见和严重（5）。此外，对治疗的反应已被证明因年龄、性别、地点和种族/民族而异，在特定群体中具有更侵袭性疾病的风险。所有这些问题都表明，确定可改变的风险因素对结果的需求尚未得到满足。在这一期的《关节炎护理与研究》中，Devlin等（6）在美国肾脏数据系统中确定的11,317例终末期肾病（ESRD）患者中，研究了与肾脏替代治疗（RRT）初始选择相关的临床因素和合并症，这些患者在12年的时间跨度内接受任何RRT。受试者年龄为18-80岁，在入组USRenal数据系统时，SLE被视为ESRD的原因。登记研究数据的来源是由主治肾病学家填写的医学证据报告表。作为该分析的结果，Devlin等人报告称，血液透析（HD）是选择的主要模式（85%），腹膜透析（PD）构成较小的一组（12.2%）。只有2.8%的患者直接进行移植。此外，在研究的时间跨度内，接受PD的患者比例从16.8%稳步下降至9.7%，同期接受抢先移植的患者比例略有增加，从1.7%增加至3.7%。在多变量分析中，在PD组中，患者更常被发现是女性、年轻人、白色人、有工作的人和私人保险人。这些PD患者通常也有更好的健康替代品（血红蛋白和白蛋白水平较高），并且比HD组高血压，而合并症，如充血性心力衰竭，外周血管疾病和无法行走与PD利用率降低相关。同样，接受抢先肾移植的患者明显更年轻，他们中有更大比例的人是私人保险，就业，白色和非西班牙裔患者，他们很少来自南方。没有关于所选肾脏替代模式的长期结局的可用数据。
Health disparities are well known to exist in systemic lupus erythematosus (SLE). The incidence and prevalence of SLE have been reported to be higher among African Americans, Asians, and Hispanics compared to European Americans in the US (1–3). A younger median age of disease incidence and prevalence in African American and Hispanic women has been noted along with lower socioeconomic status (2–4). Significant ethnic disparities have also been reported in disease outcomes, with greater damage and disease severity in African American and Texas Hispanics than in whites and Puerto Rican Hispanics in the LUpus in MInorities, NAture versus nurture cohort along with different genetic associations (4). Among the protean manifestations of SLE, the development of lupus nephritis (LN) predicts poor survival and is more common and severe in African American, Hispanic, and Asian patients in the US (5). In addition, response to treatment has been shown to vary by age, sex, location, and race/ethnicity, with risk for more aggressive disease in specific groups. All of these issues point to an unmet need for identifying modifiable risk factors for outcome. In this issue of Arthritis Care & Research, Devlin et al (6) examine the clinical factors and comorbidities associated with the initial choice of renal replacement therapies (RRTs) among 11,317 patients with LN end-stage renal disease (ESRD) identified in the US Renal Data System out of all the ESRD patients receiving any RRT during a 12-year span. The subjects were ages 18–80 years, and SLE was given as the cause of ESRD at enrollment into the USRenal Data System. The source of the registry data is a Medical Evidence Report Form completed by an attending nephrologist. As a result of this analysis, Devlin et al reported that hemodialysis (HD) was the predominant mode chosen (85%) and peritoneal dialysis (PD) constituted a smaller group (12.2%). Only 2.8% of the patients proceeded directly to transplant. In addition, over the time span of the study, there was a steady decline from 16.8% to 9.7% in the proportion of patients who were placed on PD, and there was a slight increase of 1.7% to 3.7% of patients receiving preemptive transplant in the same time period. On multivariate analyses, within the PD group, patients were more often found to be women, younger, white, employed, and privately insured. These PD patients also generally had better surrogates for health (higher hemoglobin and albumin levels) and were more hypertensive than the HD group, while comorbidities such as congestive heart failure, peripheral vascular disease, and the inability to ambulate were associated with decreased utilization of PD. Similarly, patients receiving preemptive renal transplantation were significantly younger, with a greater proportion of them being privately insured, employed, white, and non-Hispanic patients, who were less often from the South. There were no data available on the long-term outcomes specific to the renal replacement mode chosen.