TY - JOUR
T1 - Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry
T2 - Short-Term Kidney Status and Variation in Care
AU - For the CARRA Registry Investigators
AU - Smitherman, Emily A.
AU - Chahine, Rouba A.
AU - Beukelman, Timothy
AU - Lewandowski, Laura B.
AU - Rahman, AKM Fazlur
AU - Wenderfer, Scott E.
AU - Curtis, Jeffrey R.
AU - Hersh, Aimee O.
AU - Abel, N.
AU - Abulaban, K.
AU - Adams, A.
AU - Adams, M.
AU - Agbayani, R.
AU - Aiello, J.
AU - Akoghlanian, S.
AU - Alejandro, C.
AU - Allenspach, E.
AU - Alperin, R.
AU - Alpizar, M.
AU - Amarilyo, G.
AU - Ambler, W.
AU - Anderson, E.
AU - Ardoin, S.
AU - Armendariz, S.
AU - Baker, E.
AU - Balboni, I.
AU - Balevic, S.
AU - Ballenger, L.
AU - Ballinger, S.
AU - Balmuri, N.
AU - Barbar-Smiley, F.
AU - Barillas-Arias, L.
AU - Basiaga, M.
AU - Baszis, K.
AU - Becker, M.
AU - Bell-Brunson, H.
AU - Beltz, E.
AU - Benham, H.
AU - Benseler, S.
AU - Bernal, W.
AU - Beukelman, T.
AU - Bigley, T.
AU - Binstadt, B.
AU - Black, C.
AU - Blakley, M.
AU - Bohnsack, J.
AU - Boland, J.
AU - Boneparth, A.
AU - Bowman, S.
AU - Bracaglia, C.
AU - Brooks, E.
AU - Brothers, M.
AU - Brown, A.
AU - Brunner, H.
AU - Buckley, M.
AU - Buckley, M.
AU - Bukulmez, H.
AU - Bullock, D.
AU - Cameron, B.
AU - Canna, S.
AU - Cannon, L.
AU - Carper, P.
AU - Cartwright, V.
AU - Cassidy, E.
AU - Cerracchio, L.
AU - Chalom, E.
AU - Chang, J.
AU - Chang-Hoftman, A.
AU - Chauhan, V.
AU - Chira, P.
AU - Chinn, T.
AU - Chundru, K.
AU - Clairman, H.
AU - Co, D.
AU - Confair, A.
AU - Conlon, H.
AU - Connor, R.
AU - Cooper, A.
AU - Cooper, J.
AU - Cooper, S.
AU - Correll, C.
AU - Corvalan, R.
AU - Costanzo, D.
AU - Cron, R.
AU - Curiel-Duran, L.
AU - Curington, T.
AU - Curry, M.
AU - Dalrymple, A.
AU - Davis, A.
AU - Davis, C.
AU - Davis, C.
AU - Davis, T.
AU - De Benedetti, F.
AU - De Ranieri, D.
AU - Dean, J.
AU - Dedeoglu, F.
AU - DeGuzman, M.
AU - Delnay, N.
AU - Dempsey, V.
AU - DeSantis, E.
AU - Dickson, T.
AU - Dingle, J.
AU - Donaldson, B.
AU - Dorsey, E.
AU - Dover, S.
AU - Dowling, J.
AU - Drew, J.
AU - Driest, K.
AU - Du, Q.
AU - Duarte, K.
AU - Durkee, D.
AU - Duverger, E.
AU - Dvergsten, J.
AU - Eberhard, A.
AU - Eckert, M.
AU - Ede, K.
AU - Edelheit, B.
AU - Edens, C.
AU - Edens, C.
AU - Edgerly, Y.
AU - Elder, M.
AU - Ervin, B.
AU - Fadrhonc, S.
AU - Failing, C.
AU - Fair, D.
AU - Falcon, M.
AU - Favier, L.
AU - Federici, S.
AU - Feldman, B.
AU - Fennell, J.
AU - Ferguson, I.
AU - Ferguson, P.
AU - Ferreira, B.
AU - Ferrucho, R.
AU - Fields, K.
AU - Finkel, T.
AU - Fitzgerald, M.
AU - Fleming, C.
AU - Flynn, O.
AU - Fogel, L.
AU - Fox, E.
AU - Fox, M.
AU - Franco, L.
AU - Freeman, M.
AU - Fritz, K.
AU - Froese, S.
AU - Fuhlbrigge, R.
AU - Fuller, J.
AU - George, N.
AU - Gerhold, K.
AU - Gerstbacher, D.
AU - Gilbert, M.
AU - Gillispie-Taylor, M.
AU - Giverc, E.
AU - Godiwala, C.
AU - Goh, I.
AU - Goheer, H.
AU - Goldsmith, D.
AU - Gotschlich, E.
AU - Gotte, A.
AU - Gottlieb, B.
AU - Gracia, C.
AU - Graham, T.
AU - Grevich, S.
AU - Griffin, T.
AU - Griswold, J.
AU - Grom, A.
AU - Guevara, M.
AU - Guittar, P.
AU - Guzman, M.
AU - Hager, M.
AU - Hahn, T.
AU - Halyabar, O.
AU - Hammelev, E.
AU - Hance, M.
AU - Hanson, A.
AU - Harel, L.
AU - Haro, S.
AU - Harris, J.
AU - Harry, O.
AU - Hartigan, E.
AU - Hausmann, J.
AU - Hay, A.
AU - Hayward, K.
AU - Heiart, J.
AU - Hekl, K.
AU - Henderson, L.
AU - Henrickson, M.
AU - Hersh, A.
AU - Hickey, K.
AU - Hill, P.
AU - Hillyer, S.
AU - Hiraki, L.
AU - Hiskey, M.
AU - Hobday, P.
AU - Kitcharoensakkul, M.
AU - Schmitt, E.
AU - Syed, R.
AU - White, A.
AU - Yomogida, Kentaro
N1 - Publisher Copyright:
© 2022 American College of Rheumatology.
PY - 2023/7
Y1 - 2023/7
N2 - Objective: The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis. Methods: We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded. Results: We identified 222 patients with kidney biopsy–proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8–29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21–12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01–1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers. Conclusion: In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.
AB - Objective: The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis. Methods: We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded. Results: We identified 222 patients with kidney biopsy–proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8–29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21–12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01–1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers. Conclusion: In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.
UR - http://www.scopus.com/inward/record.url?scp=85143289701&partnerID=8YFLogxK
U2 - 10.1002/acr.25002
DO - 10.1002/acr.25002
M3 - Article
C2 - 36775844
AN - SCOPUS:85143289701
SN - 2151-464X
VL - 75
SP - 1553
EP - 1562
JO - Arthritis Care and Research
JF - Arthritis Care and Research
IS - 7
ER -