RATIONALE & OBJECTIVE: There is a dearth of data characterizing patients receiving kidney replacement therapy (KRT) for kidney failure due to systemic lupus erythematosus (SLE) and their clinical outcomes. The aim of this study was to describe trends in incidence and prevalence of KRT among these patients as well as to compare their outcomes versus those of patients treated with KRT for diseases other than SLE. STUDY DESIGN: Retrospective cohort study based on kidney registry data. SETTING & PARTICIPANTS: Patients recorded in 14 registries of patients receiving KRT that provided data to the European Renal Association Registry between 1992 and 2016. PREDICTOR: SLE as cause of kidney failure. OUTCOMES: Incidence and prevalence of KRT, patient survival while receiving KRT, patient and graft survival after kidney transplant, and specific causes of death. ANALYTICAL APPROACH: Kaplan-Meier methods and Cox regression models were fit to compare patient survival between the SLE and non-SLE groups, overall KRT, dialysis, and patient and graft survival after kidney transplant. RESULTS: In total, 1,826 patients commenced KRT for kidney failure due to SLE, representing an incidence of 0.80 per million population (pmp) per year. The incidence remained stable during the study period (annual percent change, 0.1% [95% CI, -0.6% to 0.8%]). Patient survival among patients with SLE receiving KRT was similar to survival in the comparator group (hazard ratio [HR], 1.11 [95% CI, 0.99-1.23]). After kidney transplant, the risk of death was greater among patients with SLE than among patients in the comparator group (HR, 1.25 [95% CI, 1.02-1.53]), whereas the risk of all-cause graft failure was similar (HR, 1.09 [95% CI, 0.95-1.27]). Ten-year patient overall survival during KRT and patient and graft survival after kidney transplant improved over the study period (HRs of 0.71 [95% CI, 0.56-0.91], 0.43 [95% CI, 0.27-0.69], and 0.60 [95% CI, 0.43-0.84], respectively). Patients with SLE receiving KRT were significantly more likely to die of infections (24.8%) than patients in the comparator group (16.9%; P < 0.001). LIMITATIONS: No data were available on extrarenal manifestations of SLE, drug treatments, comorbidities, kidney transplant characteristics, or relapses of SLE. CONCLUSIONS: The prognosis of patients with SLE receiving KRT has improved over time. Survival of patients with SLE who required KRT was similar compared with patients who required KRT for other causes of kidney failure. Survival following kidney transplants was worse among patients with SLE.

Abdominal Center Nephrology University of Helsinki and Helsinki University Hospital Helsinki Finland; Finnish Registry for Kidney Diseases Helsinki Finland

Austrian Dialysis and Transplant Registry Department of Internal Medicine 4 Nephrology and Hypertension Medical University Innsbruck Innsbruck Austria

Department of Clinical Sciences Division of Nephrology Lund University and Skane University Hospital Lund Sweden

Department of Medicine Haukeland University Hospital Bergen Norway; Department of Clinical Medicine University of Bergen Bergen Norway

Department of Medicine Holbaek Hospital Holbaek Denmark

Department of Nephrology 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Department of Nephrology Dialysis and Hypertension Dutch speaking Belgian Renal Registry Sint Niklaas Belgium

Department of Nephrology Faculty of Medicine Hacettepe University Ankara Turkey

Division of Nephrology Ambroise Paré University Hospital Assistance Publique Hôpitaux de Paris Boulogne Billancourt Paris France; INSERM Unit 1018 Team 5 Research Centre in Epidemiology and Population Health University of Paris Ouest Versailles Saint Quentin en Yveline Villejuif France

Division of Nephrology Landspitali The National University Hospital of Iceland Reykjavik Iceland; Faculty of Medicine School of Health Sciences University of Iceland Reykjavik Iceland

Dutch Renal Registry Renine Nefrovisie Foundation Utrecht the Netherlands; Department of Internal Medicine Division of Nephrology Maastricht University Medical Center Maastricht The Netherlands

ERA Registry Amsterdam UMC University of Amsterdam Department of Medical Informatics Amsterdam Public Health Research Institute Amsterdam the Netherlands

French Belgian ESRD Registry Brussels Belgium

Scottish Renal Registry Meredian Court Information Services Division Scotland Glasgow United Kingdom

Servicio Nefrologia Hospital Regional de Málaga Málaga Spain

Unité de Néphrologie Service de Pédiatrie Centre Hospitalier Universitaire de Bordeaux Université de Bordeaux Institut National de la Santé et de la Recherche Médicale U1219 Bordeaux France

Valencia Region Renal Registry Direccio General de Salut Publica i Adiccions Valencia Spain; Department of Preventive Medicine and Public Health Universitat de Valencia Valencia Spain; Rare Diseases Joint Research Unit Universitat de Valencia Foundation for the Promotion of Health and Biomedical Research in the Valencian Region Renal Registry FISABIO Valencia Spain; Spanish Consortium for Research on Epidemiology and Public Health Madrid Spain

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