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Incidence of progression from newly diagnosed systemic lupus erythematosus to end stage renal disease and all‐cause mortality: a nationwide cohort study in T aiwan
Author(s) -
Lin WeiHung,
Guo ChaoYu,
Wang WeiMing,
Yang DengChi,
Kuo TeHui,
Liu MingFei,
Wang MingCheng
Publication year - 2013
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.12208
Subject(s) - medicine , end stage renal disease , lupus nephritis , incidence (geometry) , cohort , hazard ratio , population , cohort study , disease , proportional hazards model , confidence interval , environmental health , physics , optics
Aim End‐stage renal disease ( ESRD ) is a common finding in systemic lupus erythematosus ( SLE ) and may contribute to mortality. The purpose of the study was to investigate the incidence of ESRD and all‐cause mortality and their risk factors in patients newly diagnosed with SLE in Taiwan. Methods This nationwide cohort study used data from the N ational H ealth I nsurance R esearch D atabase. We identified 4130 newly diagnosed SLE patients at risk for ESRD during 2000–2002; among them, 103 developed ESRD by the end of 2008. Additional 412 age‐ and sex‐matched incident ESRD non‐ SLE patients served as controls for the survival analysis. Results Of the newly diagnosed SLE patients, 2.5% developed ESRD . Age (adjusted hazards ratio [ HR ] 0.66 for each 1‐year increase; 95% confidence interval [ CI ] 0.47–0.94) and male gender (adjusted HR 2.24; 95% CI 1.4–3.6) were significantly associated with ESRD development. Survival analysis conducted after ESRD development revealed a higher mortality risk among the older patients ( HR 1.04; 95% CI 1.02–1.05). Survival analysis in the younger population (age < 40 years) after ESRD development revealed a significant mortality risk among SLE patients ( HR 2.73; 95% CI 1.22–6.07). Conclusion In the follow‐up of newly diagnosed SLE patients in T aiwan, younger age and male gender were risk factors for ESRD development. After entering ESRD , these risk factors had different impacts on mortality. Despite the overall improvement in care of patients with lupus nephritis, survival is still poorer in the younger age population.