Hemodialysis Preferred Therapy in End-Stage Lupus Nephritis

Race, ethnicity, employment, insurance influence choice for peritoneal dialysis as initial therapy

WEDNESDAY, Nov. 9 (HealthDay News) -- Most patients with lupus nephritis (LN) end stage renal disease (ESRD) undergo hemodialysis (HD), and few receive peritoneal dialysis (PD) or pre-emptive kidney transplantation, according to a study published online Nov. 4 in Arthritis Care & Research.

Amy Devlin, M.D., from Harvard Medical School in Boston, and colleagues investigated the sociodemographic and clinical factors associated with variation in initial kidney replacement therapies in 11,317 LN ESRD patients. In age- and multivariable-adjusted logistic regression analyses, the impact of age, gender, race, ethnicity, medical insurance, employment status, residential region, clinical factors, and comorbidities were evaluated on the choice of ESRC treatment (PD, HD, or pre-emptive kidney transplantation).

The investigators found that 82.0 and 12.2 percent of patients initiated HD and PD, respectively, while 2.8 percent underwent pre-emptive kidney transplantation. A significant association was found for initiating PD and earlier calendar year, female gender, higher albumin and hemoglobin, and lower serum creatinine levels. Patients who were African-American (versus white), Medicaid beneficiaries, those without health insurance (versus private insurance), and those who were unemployed (versus employed) were significantly less likely to initiate PD. Decreased PD was associated with comorbidities, including congestive heart failure, peripheral vascular disease, and inability to ambulate. Many of the sociodemographic and clinical factors which favored PD also correlated with pre-emptive transplant versus hemodialysis.

"Few patients with LN ESRD receive initial PD or pre-emptive kidney transplantation. Race, ethnicity, employment, and medical insurance type are strongly associated with initial kidney replacement therapy choice," the authors write.

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