Original Investigation
Cardiovascular and cerebrovascular morbidity and mortality among women with end-stage renal disease attributable to lupus nephritis*,**

https://doi.org/10.1053/ajkd.2000.9792Get rights and content

Abstract

Cardiovascular and cerebrovascular diseases are common causes of morbidity and mortality in women with systemic lupus erythematosus (SLE) and are also common in patients with end-stage renal disease (ESRD). To determine whether women with ESRD caused by lupus nephritis are at greater risk for morbidity from these conditions than women with other causes of ESRD, data from the US Renal Data System were used to compare incidence rates of hospitalizations for acute myocardial infarction and cerebrovascular accident between women with ESRD caused by lupus nephritis and women with ESRD from other causes. The age- and race-adjusted incidences of hospitalizations for acute myocardial infarction during dialysis were 16.4 hospitalizations/1,000 patient-years among women with ESRD caused by lupus nephritis and 17.3 hospitalizations/1,000 patient-years among women in the comparison group (adjusted hazard ratio, 0.80; 95% confidence interval [CI], 0.58 to 1.08; P = 0.14). Adjusted incidence rates for acute myocardial infarction after renal transplantation also did not differ between these groups. Adjusted incidence rates for hospitalizations for cerebrovascular accident during dialysis were 18.5 hospitalizations/1,000 patient-years among women with ESRD caused by lupus nephritis and 19.2 hospitalizations/1,000 patient-years among women in the comparison group (adjusted hazard ratio, 0.87; 95% CI, 0.66 to 1.14; P = 0.30); incidence rates after transplantation also did not differ between groups. Risks for death from cardiovascular or cerebrovascular diseases also were not increased among women with ESRD caused by lupus nephritis. Sepsis was the most common cause of death in this group. Morbidity and mortality from acute myocardial infarction and cerebrovascular accident were substantially greater among women with ESRD caused by diabetes mellitus. Although morbidity and mortality from cardiovascular and cerebrovascular diseases are common among women with SLE, risks for these outcomes are not greater among women with ESRD caused by lupus nephritis than among other women without diabetes with ESRD.

Section snippets

Data

Data used in this study were those of the USRDS. The USRDS has collected information on all patients in the United States who have received Medicare-reimbursed maintenance renal replacement therapy since 1977.44 This database is estimated to include approximately 94% of the patients who receive renal replacement therapy in the United States. Patients must be receiving chronic dialysis therapy or have undergone renal transplantation to be included in this database.

This longitudinal database

Results

Women with ESRD caused by lupus nephritis comprised 2.0% of the study group undergoing dialysis (n = 3,431) and 5.0% of the study group that had received a renal transplant (n = 946). Compared with women with ESRD caused by diabetes mellitus and women with ESRD from other causes, women with ESRD caused by lupus nephritis were significantly younger (Table 1).

. Characteristics of Patients by Diagnosis of Attributed Cause of ESRD

Empty CellLupus NephritisDiabetes MellitusOther CausesP
On dialysis
No. of

Discussion

In this study, women with ESRD caused by lupus nephritis had rates of hospitalizations for acute myocardial infarction and cerebrovascular accident similar to those of women with ESRD from causes other than diabetes mellitus or lupus nephritis. This similarity held during periods of dialysis and after renal transplantation. Deaths from these conditions did not occur more commonly among women with ESRD caused by lupus nephritis. Conversely, risks for both hospitalization and death from acute

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    *

    Supported in part by the Maudie Long Gift Fund at the Veterans Affairs Palo Alto Health Care System.

    **

    Address reprint requests to Michael M. Ward, MD, VA Palo Alto Health Care System 111G, 3801 Miranda Ave, Palo Alto, CA 94305. E-mail: [email protected].

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