children with systemic lupus erythematosus (SLE) and only slightly more than half of patients with childhood-onset LN enter a renal remission. Thus, children with LN are at high risk of developing ESRD. Previous studies have shown that children with ESRD due to LN have increased risk of death compared to those with ESRD from all other causes. The outcomes of children with LN on dialysis are poorly characterized and little is known about specific risk factors for mortality and morbidity in children with LN on dialysis. Methods: To characterize hospitalization risk, mortality risk, and time to kidney transplantation among LN patients on dialysis, we conducted a retrospective analysis of North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) registry data of children and adolescents <21 years of age initiating dialysis from 1991-2018. We included all patients with LN listed as their underlying cause of kidney disease (N¼238). Patients with non-lupus glomerular diseases (N¼2,006) served as the comparison group. Contingency tables used to compare risk of hospitalization within 1 year of dialysis initiation. Survival analysis used to compare time to mortality and transplantation and multivariable Cox regression models used to compare risk of death and likelihood of transplantation following dialysis initiation, adjusting for patient age, race, sex, index dialysis modality, hypertension, and anemia. Results: In comparison to the control group, patients with LN were more likely to be older (age >13 years), females, African American, and more likely to be receiving hemodialysis (p<0.01 for all). The number of concomitant medications they receive is also significantly more than the control group. They were more likely to be hospitalized in the first year following dialysis initiation (63.4% vs 50.4%, p<0.001), had a higher risk of death following dialysis initiation (Figure 1), even after adjusting for patient age, race, sex, and index dialysis modality (aHR¼2.09, 95% CI 1.25-3.35, p¼0.003). Children with LN also demonstrated a lower likelihood of receiving a kidney transplant following dialysis initiation (Figure 2), even after adjusting for patient age, race, sex, index dialysis modality, hypertension, and anemia (aHR¼0.65, 95% CI 0.52-0.81, p<0.001). Conclusions: LN is more common in adolescents, African-Americans, females and are likely to be receiving hemodialysis. Even after controlling for these variable, children and adolescents with LN have an
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