ACR Meeting Abstracts

ACR Meeting Abstracts

  • Meetings
    • ACR Convergence 2024
    • ACR Convergence 2023
    • 2023 ACR/ARP PRSYM
    • ACR Convergence 2022
    • ACR Convergence 2021
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • View and print all favorites
    • Clear all your favorites
  • ACR Meetings

Abstract Number: 2622

Quality of Care for Childhood-Onset Lupus Nephritis: Suboptimal Completion of Disease Activity Monitoring

Emily Smitherman1, Justin Leach1, Aimee Hersh2, Melissa Mannion1, Jinoos Yazdany3 and Jeffrey Curtis4, 1University of Alabama at Birmingham, Birmingham, AL, 2University of Utah, Salt Lake City, UT, 3UCSF, San Francisco, CA, 4University of Alabama at Birmingham, Hoover, AL

Meeting: ACR Convergence 2024

Keywords: Administrative Data, Pediatric rheumatology, Quality Indicators, Systemic lupus erythematosus (SLE)

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print
Session Information

Date: Monday, November 18, 2024

Title: Abstracts: Measures & Measurement of Healthcare Quality

Session Type: Abstract Session

Session Time: 3:00PM-4:30PM

Background/Purpose: Poorly controlled childhood-onset lupus nephritis (cLN) can lead to end-stage kidney disease (ESKD), requiring kidney replacement therapies with substantial financial and quality of life burden. It is unknown if children with LN reliably receive guideline-concordant care. Here we assessed performance of cLN quality measures, including clinical follow-up every 3 months and laboratory monitoring of nephritis and lupus disease activity at diagnosis and every 3 months.

Methods: We performed a retrospective cohort study of US-based Merative MarketScan Commercial® and 8-State Medicaid Research Databases 2006-2020. Childhood systemic lupus erythematosus (cSLE) was defined as: ≥ 3 outpatient or inpatient visits with SLE International Classification of Diseases (ICD) diagnosis codes, 30-365 days apart, and age 5-18 years at first eligible code. We excluded individuals with: < 6 months of active enrollment in medical and drug coverage prior to first SLE code and any claims for SLE drug use ≥ 6 months before the first SLE code. Among those with cSLE, our approach to identify cLN was: ≥ 2 ambulatory or inpatient visits with ICD diagnosis codes for kidney disease, 30-365 days apart, and occurring 90 days before or any time following first SLE code. We excluded individuals with less than 365 days of enrollment following their first cLN code. We then identified all nephritis monitoring labs (urinalysis, serum creatinine, urine protein to creatinine ratio) and SLE disease activity monitoring labs (complement levels, double-stranded DNA [dsDNA]) using Current Procedural Terminology (CPT) codes. We categorized whether at least one outpatient visit with SLE or LN codes and any laboratory monitoring was completed at least once during each 90-day period in the year following the first LN code.

Results: We identified 667 individuals receiving cLN care for at least 365 days from 2006-2020. The majority of cLN patients were female (82%) and commercially-insured (58%), with median (IQR) age at index diagnosis of 15 (13-17) years. During the 365 days following the first LN diagnosis code, 64% of patients completed an outpatient visit at least once every 90 days and 60% completed any LN disease monitoring – 50% urinalysis, 43% serum creatinine, and 39% urine protein to creatinine ratio (Table 1). For SLE disease activity monitoring, 40% completed complement monitoring and 29% completed dsDNA at least once every 90 days. Of note, in the 365 days following the first LN diagnosis code, 19% of individuals completed no LN monitoring, 35% no dsDNA monitoring, and 29% no complement monitoring. For each monitoring type, the percentage of individuals with at least one encounter indicating monitoring within each 90-day period decreased slightly over time (Figure 1).

Conclusion: Using contemporary real-world data for children with cLN, we observed suboptimal completion of cLN disease monitoring, as measured by clinical visits and laboratory assessments, in the year following first LN diagnosis code. Our next step is to analyze the association between appropriate monitoring and development of ESKD. Based on these initial findings, interventions are needed to improve quality of care for patients with cLN.

Supporting image 1

Supporting image 2

Abbreviations: cLN = childhood-onset lupus nephritis; Cr = creatinine; uPCR = urine protein to creatinine ratio; double-stranded DNA = dsDNA.


Disclosures: E. Smitherman: None; J. Leach: None; A. Hersh: None; M. Mannion: NIAMS K23AR081410, 5, Rheumatology Research Foundation, 5; J. Yazdany: AstraZeneca, 2, Aurinia, 5, Bristol-Myers Squibb(BMS), 2, UCB, 2; J. Curtis: AbbVie, 2, 5, Amgen, 2, 5, Aqtual, 5, Bendcare, 2, 5, Bristol-Myers Squibb(BMS), 5, Corrona, 2, 5, Crescendo, 2, 5, Eli Lilly, 2, 5, FASTER, 2, 4, Genentech, 2, 5, GlaxoSmithKlein(GSK), 2, 5, Janssen, 2, 5, Moderna, 2, 5, Novartis, 2, 5, Pfizer, 2, 5, Roche, 2, 5, Sanofi, 2, 5, UCB Pharma, 2, 5.

To cite this abstract in AMA style:

Smitherman E, Leach J, Hersh A, Mannion M, Yazdany J, Curtis J. Quality of Care for Childhood-Onset Lupus Nephritis: Suboptimal Completion of Disease Activity Monitoring [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/quality-of-care-for-childhood-onset-lupus-nephritis-suboptimal-completion-of-disease-activity-monitoring/. Accessed .
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print

« Back to ACR Convergence 2024

ACR Meeting Abstracts - https://acrabstracts.org/abstract/quality-of-care-for-childhood-onset-lupus-nephritis-suboptimal-completion-of-disease-activity-monitoring/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts during your browser session by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

All abstracts accepted to ACR Convergence are under media embargo once the ACR has notified presenters of their abstract’s acceptance. They may be presented at other meetings or published as manuscripts after this time but should not be discussed in non-scholarly venues or outlets. The following embargo policies are strictly enforced by the ACR.

Accepted abstracts are made available to the public online in advance of the meeting and are published in a special online supplement of our scientific journal, Arthritis & Rheumatology. Information contained in those abstracts may not be released until the abstracts appear online. In an exception to the media embargo, academic institutions, private organizations, and companies with products whose value may be influenced by information contained in an abstract may issue a press release to coincide with the availability of an ACR abstract on the ACR website. However, the ACR continues to require that information that goes beyond that contained in the abstract (e.g., discussion of the abstract done as part of editorial news coverage) is under media embargo until 10:00 AM ET on November 14, 2024. Journalists with access to embargoed information cannot release articles or editorial news coverage before this time. Editorial news coverage is considered original articles/videos developed by employed journalists to report facts, commentary, and subject matter expert quotes in a narrative form using a variety of sources (e.g., research, announcements, press releases, events, etc.).

Violation of this policy may result in the abstract being withdrawn from the meeting and other measures deemed appropriate. Authors are responsible for notifying colleagues, institutions, communications firms, and all other stakeholders related to the development or promotion of the abstract about this policy. If you have questions about the ACR abstract embargo policy, please contact ACR abstracts staff at [email protected].

Wiley

  • Online Journal
  • Privacy Policy
  • Permissions Policies
  • Cookie Preferences

© Copyright 2025 American College of Rheumatology