Abstract: PO1599
The Relationship Between Renal Flares and Continuity of Medical Care in Patients with Lupus Nephritis
Session Information
- Glomerular Diseases: Clinicopathological Features and Outcomes in IgAN, Lupus Nephritis, and Vasculitis
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Alsharhan, Loulwa, Kuwait Ministry of Health, Safat, Al Asimah, Kuwait
- Schmidt, Insa Marie, Boston University, Boston, Massachusetts, United States
- Bonegio, Ramon, Boston University, Boston, Massachusetts, United States
- York, Michael R., Boston University, Boston, Massachusetts, United States
- Lam, Christina, Boston University, Boston, Massachusetts, United States
- Crespo-Bosque, Monica, Boston University, Boston, Massachusetts, United States
- Waikar, Sushrut S., Boston University, Boston, Massachusetts, United States
- Menn-Josephy, Hanni, Boston University, Boston, Massachusetts, United States
Background
African American and Hispanic patients with lupus nephritis (LN) are known to have worse clinical outcomes compared to those of white patients, with higher prevalence of severe inflammatory nephritis, higher rates of doubling creatinine, End Stage Kidney Disease (ESKD) and death. In this study, we characterized the frequency and severity of renal flares of patients treated in our lupus nephritis clinic.
Methods
Patient demographics are presented as mean ±SD; student t-tests were used when appropriate; Chi-square tests were used to determine differences in the number of renal flares and the number of missed appointments (dichotomized into 0 vs. >=1).
Results
Between 2005–2019, a total of 116 patients with Lupus Nephritis treated at the multidisciplinary lupus clinic in a safety net hospital in Boston, MA were enrolled in our study. 23.3% of patients (n=27) self-identified as white or Asian and non-Hispanic (group 1); 76.7% of patients (n=89) self-identified as Black, African American and/or Hispanic (group 2). Patients’ demographics and disease characteristics were similar between the two groups. Over the duration of the study, 59.5% of patients (n=69) did not experience any flare, and 40.5% of patients (n=47) experienced ≥1 flares. Of the patients that experienced ≥1 flares, 89% (n=42) missed one or more appointments over the course of the study. The rate of missed appointments in group 2 was significantly higher than the one observed in group 1 (85.4% vs. 48.1% respectively, p≤0.001).
Conclusion
This study represents one of the largest cohorts of patients with lupus nephritis with consistent, longitudinal, long term follow up. We found that in our black, African American and/or Hispanic patient population, there was a significant association between renal flares and missed appointments. In our safety net hospital setting, missed appointments frequently represents patients’ inability to access care due to various challenges including lack of sick days at work, transportation challenges, access to certain technologies and language barriers. When looking to reduce racial and ethnical health care disparities, we should design interventions that are aimed at removing key barrier to health care access.