Lupus nephritis – An update on disparities affecting african americans

Portalatin, Gilda M.; Gebreselassie, Surafel; Bobart, Shane A.

doi:10.1016/j.jnma.2022.05.005

Cited by 5 publications

(5 citation statements)

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“…A few ongoing trends hold true: Black patients were more likely to have FSGS lesions, likely due to the known association with APOL1 risk alleles (11). Females were more likely to have lupus nephritis, a disease that disproportionately affects Black and Hispanic patients (12), thus explaining why Florida had a higher OR for LN. Hispanic and Black patients were more likely to have DKD, similar to the increased prevalence of diabetes in these populations, and consistent with United States Renal Data System data (2).…”

Section: Discussionmentioning

confidence: 99%

The Cleveland Clinic Kidney Biopsy Epidemiological Project

et al. 2022

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Background: The kidney biopsy is the gold standard for the diagnosis of glomerular diseases. Large-scale, epidemiological studies describing the prevalence of kidney diseases are lacking especially in the US. We aimed to determine the spectrum of biopsy proven kidney disease across the Cleveland Clinic enterprise. Methods: We identified all patients with a native kidney biopsy performed/reviewed at the Cleveland Clinic from January 2015 to September 2021. Retrospective chart review was performed to obtain clinical and demographic characteristics. Results were stratified by age, gender, race and location to determine epidemiological trends. Results: Of over 9600 patients, we excluded transplant/donor biopsies and unavailable records, and included 4128 patients with native kidney biopsy data. The median age was 60 years, with 46.2% female patients. Self-reported racial demographics included 72.9% White, 21.7% Black, 3.1% multi-racial, and 1.6% Asian background, with 5.1% Hispanic. Common diagnoses were: FSGS (n=633, 15.3%), diabetic kidney disease (DKD) (n=602, 14.6%), IgA nephropathy (n=319, 7.7%), lupus nephritis (LN) (n=289, 7.0%), pauci-immune glomerulonephritis (n=275, 6.7%), membranous nephropathy (n=211, 5.1%), and amyloidosis (n=110, 2.7%). There were 3322 patients in Ohio, with 361 patients in Florida. Using multivariate analysis, those over 70 years were more likely to have FSGS, while those less than 45 years were more likely to have IgA Nephropathy or LN. Males were more likely to have FSGS or IgAN and less likely to have LN. Blacks were more likely to have FSGS, DKD or LN. Hispanics were more likely to have DKD. Finally, patients in Florida were more likely to have LN. There was no change in the disease spectrum prior to and during the COVID 19 pandemic. Conclusion: Our study catalogues the spectrum of biopsy proven kidney disease across the Cleveland Clinic enterprise. This lays the foundation for glomerular disease clinical trials and highlights the need for a standardized national kidney biopsy registry to bolster glomerular and kidney disease research in the United States.

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Section: Discussionmentioning

confidence: 99%

The Cleveland Clinic Kidney Biopsy Epidemiological Project

et al. 2022

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“…During ICU admission, the most frequent treatment and medications were glucocorticoids (93.4%), antibiotics (either therapeutic or empirical) (71.4%), plasmapheresis (34.1%), and cyclophosphamide (20.9%). The mean APACHE II score at admission was 15 ± 8.6, and the median length of ICU stay was 7 [3][4][5][6][7][8][9][10][11][12][13][14][15] days. Also, 56% underwent mechanical ventilation, and 29.7% underwent renal replacement therapy; among them, 26.4% were known cases of ESRD, and 3.3% were new cases of AKI.…”

Section: Resultsmentioning

confidence: 99%

“…Several factors can affect the severity, mortality, and outcome of the diseases too, as a study by Portalatin et al showed genetic predisposition to both SLE and chronic kidney disease in African Americans ancestry patients and their income inequality, education disparities, lack of support, health care access, and affordability can induce higher rates of progression of them to end stage renal disease (ESRD) and have a better access to healthcare and social support systems making new and alternative regimens more affordable and cost-effective [7]. In the era of the coronavirus disease (COVID- 19), studies have also showed that patients with autoimmune disease had better outcomes with COVID-19 than controls [8,9].…”

Section: Introductionmentioning

confidence: 99%

Determination of the main causes, outcome, and prognostic factors of patients with rheumatologic diseases admitted to the medical intensive care unit in Southern Iran

et al. 2022

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Background Systemic rheumatic diseases (SRD) are a heterogeneous group of diseases that can involve several organ systems and occasionally requires intensive care unit (ICU) admission because of severe systemic disease, life-threatening organ involvement, or complication of treatment. The objective of this study is to determine the causes, outcome, and prognostic factors of patients with rheumatologic diseases admitted in teaching medical ICUs in southern Iran. Methods A retrospective case review of all patients with rheumatologic diseases admitted in the academic medical ICUs in two referral hospitals in southern Iran, from March 2015 to January 2020. Patients’ data were documented from their hospital records and the cause of admission, in-hospital outcome, and prognostic factors was evaluated. Results Ninety-one patients were included, of which 71.4% were female. Systemic lupus erythematosus (54.9%) was the most common disease. Nineteen (20.9%) patients were new cases of rheumatological disease. The most frequent symptom for admittance was dyspnea (54.9%) and hemoptysis (20.9%). The in-hospital mortality rate was 48%, and the leading cause of death was infection (29 patients; 65.5%) followed by disease activity (18 patients; 40.9%). Also, the death of 29.5% of patients was presumed due to both disease activity and infection. Factors associated with mortality included renal insufficiency ( p < 0.028), infection ( p < 0.001), pneumonia ( p < 0.042), dyspnea ( p < 0.042), loss of consciousness ( p < 0.046), azathioprine consumption ( p < 0.004) during 1 month before ICU admission, mechanical ventilation ( p < 0.001), renal replacement therapy ( p < 0.001), CNS involvement ( p < 0.009), and ICU medications such as cyclosporine and azathioprine (0.03 and 0.03, respectively) or treatments such as plasmapheresis ( p < 0.018). Conclusion The ICU mortality rate of patients with SRD was high. Infection and disease exacerbation are the leading reasons for ICU admission in systemic rheumatic diseases. Intensivists must keep in mind that SRD exacerbation may require immunosuppressive agents along with lifesaving interventions, more particularly in newly diagnosed SRDs. Key Points • The ICU mortality rate of patients with SRD was high. • Infection and disease exacerbation are the leading reasons for ICU admission in systemic rheumatic diseases. • 63.8% of our patients fall into this category of new cases of rheumatologic disease and disease flare-up.

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“…In a study analyzing the mortality trend of SLE patients across 46 years, Black patients suffered a higher mortality rate and at a younger age in comparison to their White counterparts [ 12 ]. Furthermore, prior studies have identified Black SLE patients as having higher rates of progression toward end-stage renal disease [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Analysis of Cutaneous Lupus Hospitalizations: A United States National Population-Based Study

He,

Hino,

Aihie

et al. 2023

Cureus

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Background There are limited studies analyzing cutaneous lupus erythematosus (CLE) hospitalizations. In this study, we aimed to analyze baseline demographics of systemic lupus erythematosus (SLE) and CLE patients, identify the most common reasons for hospitalizations, and find out the hospitalization outcomes. Materials and methods We performed the analysis using the National (Nationwide) Inpatient Sample (NIS) database between 2016 and 2019. For the CLE cohort, data for adults aged 18 years and older with the primary or secondary diagnosis of CLE using International Classification of Disease - 10th revision (ICD-10) codes were extracted. For comparison, the SLE cohort was identified by patients aged 18 years and older with primary or secondary diagnoses of SLE using ICD-10 codes. Chi-squared test was used to compare baseline demographic characteristics. Multivariable logistic and linear regression was used to calculate outcomes of interest. Results In comparison to the SLE cohort, the CLE cohort was not only older in age and lower percentage female, but also had shorter length of stay, less total hospital charge, and the majority had Medicare as primary insurance. The SLE cohort included predominantly African American patients while the CLE cohort was majority Caucasian patients. The cardiovascular risks were more prevalent in the CLE cohort and most commonly admitted for sepsis, cardiovascular disease, and mental health disorders. Conclusion Our study highlights the importance of outpatient follow-up in CLE patients to closely monitor cardiovascular risk factors, early identification of infections, and routine mental health screenings to reduce hospitalizations and resource utilization.

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Lupus nephritis – An update on disparities affecting african americans

Cited by 5 publications

References 55 publications

The Cleveland Clinic Kidney Biopsy Epidemiological Project

The Cleveland Clinic Kidney Biopsy Epidemiological Project

Determination of the main causes, outcome, and prognostic factors of patients with rheumatologic diseases admitted to the medical intensive care unit in Southern Iran

Analysis of Cutaneous Lupus Hospitalizations: A United States National Population-Based Study

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