Background/Purpose:
The attributed
cause of end-stage renal disease (ESRD) in the United States Renal Data System
(USRDS) is often used to identify systemic lupus erythematosus (SLE) patients
in U.S. studies of ESRD incidence and quality of care. We aimed to compare the attributed
ESRD cause from the USRDS to the validated SLE status of patients in the
Georgia Lupus Registry (GLR) who had progressed to ESRD.

Methods: Data from the USRDS were linked
to the GLR to identify SLE patients (diagnosed through 12/04) who progressed to
ESRD (through 9/12). The percentage of these SLE patients whose ESRD was
subsequently attributed to SLE in the USRDS was calculated, overall and by
patient characteristics.

Results: Among 251 SLE patients who
progressed to ESRD, 78.9% had their ESRD attributed to SLE in the USRDS. Of the
remaining 53 patients, most had their ESRD attributed to hypertension, diabetes
mellitus, and non-SLE-related glomerulonephritis (Figure). Attribution of ESRD
to SLE did not differ by sex or race but was lower among older vs. younger patients
(P<0.001; Table). Only 20.0% of those aged ≥50 had ESRD
attributed to SLE. Having Medicaid or no insurance was associated with greater
attribution of ESRD to SLE than having private insurance (P=0.02), as
was having two or more providers state a SLE diagnosis (P=0.008).

Conclusion: These estimates indicate that
USRDS-based studies may underreport ESRD in U.S. SLE patients. However,
observed patterns of differential attribution of ESRD cause, particularly by
age, suggest that providers may be correctly attributing ESRD to causes other
than SLE and lupus nephritis among some SLE patients.