Dataset Information

Kidney Transplantation and Cardiovascular Events Among Patients With End-Stage Renal Disease Due to Lupus Nephritis: A Nationwide Cohort Study.

ABSTRACT:

Objective

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).

Methods

In a nationwide cohort study, we identified all patients with LN-ESRD enrolled in the US 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 infarction (MI) and ischemic cerebrovascular accident (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 Index score, and history of prior organ transplants.

Results

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 American patients 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% confidence interval (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).

Conclusion

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.

SUBMITTER: Jorge A

PROVIDER: S-EPMC8666461 | biostudies-literature | 2022 Nov

REPOSITORIES: biostudies-literature

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Publications

Kidney Transplantation and Cardiovascular Events Among Patients With End-Stage Renal Disease Due to Lupus Nephritis: A Nationwide Cohort Study.

Jorge April A Fu Xiaoqing X Cook Claire C Lu Na N Zhang Yuqing Y Choi Hyon K HK Wallace Zachary S ZS

Arthritis care & research 20220803 11

<h4>Objective</h4>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).<h4>Methods</h4>In a nationwide cohort study, we identified all patients with LN-ESRD enrolled in the US 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 infarction (MI) a ...[more]

PMID: 34121367

Similar Datasets

Project description:ObjectiveFor the majority of patients with lupus nephritis-related end-stage kidney disease (LN-ESKD), kidney transplant is associated with better outcomes than dialysis. Access to kidney transplant requires an initial referral to a transplant center and medical evaluation prior to waitlisting. The study's objective was to examine access to these early steps in the kidney transplant process among patients with LN-ESKD.MethodsAdults who began treatment for ESKD in the Southeast, Northeast, New York, or Ohio River Valley U.S. regions from 1/1/2012 to 12/31/2019, followed through 6/30/2021, were identified from the United States Renal Data System. Referral and evaluation start data were collected from 28 of 48 transplant centers across these regions. The exposure was primary cause of ESKD (LN-ESKD vs other-ESKD). The outcomes were referral and evaluation start at a transplant center. Cox models quantified the association between LN-ESKD (vs other-ESKD) and referral and evaluation start.ResultsAmong 192,318 patients initiating treatment for ESKD, 0.4% had LN-ESKD. Over half (58%) of LN-ESKD patients were referred before study end, and among those referred, 66% started the evaluation. In adjusted analyses, patients with LN-ESKD were referred (HR: 1.09, 95% CI: 0.99, 1.19) and started the transplant evaluation (HR: 1.13, 95% CI: 1.00, 1.28) at a higher rate than patients with other-ESKD. Among referred patients with LN-ESKD, the median time from ESKD start to referral was 2.9 months (IQR: <1 to 11.7 months), which is similar to patients with other-ESKD (median 2.6 months, IQR: <1 to 8.8 months).ConclusionsAmong incident patients with ESKD, having a primary diagnosis of LN-ESKD versus other-ESKD is associated with higher rates of early transplant access outcomes. Despite this, patients with LN-ESKD (vs other-ESKD) are less likely to be preemptively referred (i.e., referred prior to ESKD start) for kidney transplant. While providers may no longer be delaying the early steps in the kidney transplantation process among this patient population, there is still room for improvement in the rates of preemptive referral. Access to kidney transplant referral prior to ESKD could result in increased transplant rates and better transplant outcomes for patients with LN-ESKD.

Project description:BACKGROUND:Cardiovascular disease is a significant cause of morbidity and mortality in patients with end-stage renal disease (ESRD) and kidney transplant (KT) patients. Compared with left ventricular (LV) ejection fraction (LVEF), LV strain has emerged as an important marker of LV function as it is less load dependent. We sought to evaluate changes in LV strain using cardiovascular magnetic resonance imaging (CMR) in ESRD patients who received KT, to determine whether KT may improve LV function. METHODS:We conducted a prospective multi-centre longitudinal study of 79 ESRD patients (40 on dialysis, 39 underwent KT). CMR was performed at baseline and at 12 months after KT. RESULTS:Among 79 participants (mean age 55 years; 30% women), KT patients had significant improvement in global circumferential strain (GCS) (p = 0.007) and global radial strain (GRS) (p = 0.003), but a decline in global longitudinal strain (GLS) over 12 months (p = 0.026), while no significant change in any LV strain was observed in the ongoing dialysis group. For KT patients, the improvement in LV strain paralleled improvement in LVEF (57.4 ± 6.4% at baseline, 60.6% ± 6.9% at 12 months; p = 0.001). For entire cohort, over 12 months, change in LVEF was significantly correlated with change in GCS (Spearman's r = - 0.42, p < 0.001), GRS (Spearman's r = 0.64, p < 0.001), and GLS (Spearman's r = - 0.34, p = 0.002). Improvements in GCS and GRS over 12 months were significantly correlated with reductions in LV end-diastolic volume index and LV end-systolic volume index (all p < 0.05), but not with change in blood pressure (all p > 0.10). CONCLUSIONS:Compared with continuation of dialysis, KT was associated with significant improvements in LV strain metrics of GCS and GRS after 12 months, which did not correlate with blood pressure change. This supports the notion that KT has favorable effects on LV function beyond volume and blood pessure control. Larger studies with longer follow-up are needed to confirm these findings.

Dataset Information

Kidney Transplantation and Cardiovascular Events Among Patients With End-Stage Renal Disease Due to Lupus Nephritis: A Nationwide Cohort Study.

Objective

Methods

Results

Conclusion

Publications

Kidney Transplantation and Cardiovascular Events Among Patients With End-Stage Renal Disease Due to Lupus Nephritis: A Nationwide Cohort Study.

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