Influence of predialysis comorbidity and damage accrual on mortality in lupus patients treated with peritoneal dialysis

Abstract

The predialysis CCI, instead of SDI, determines an increased risk for mortality in lupus patients treated with PD. The prognosis of lupus patients treated with PD largely depends on the severity of predialysis comorbidity, especially cardiovascular diseases.

The effect of comorbidity on hospital mortality in patients with SLE from an Asian tertiary hospital

“…34 Similarly, pre-dialysis comorbid illnesses as determined by the CCI, but not increased severity of pre-dialysis damage accrual, predicts all-cause mortality in lupus patients treated with peritoneal dialysis. 35 Comorbidity as a predictor for mortality and hospital LOS had also been reported in patients with cancer, 36 patients with acute burn injury, 37 patients with cirrhosis, 25 patients with sepsis, 38 critically ill patients in the ICU, 16 and a general hospital population. 20 It is well known that death is rarely due to uncontrolled lupus episodes but rather attributable to side effects of treatments in the late course of SLE.…”

“…20 It is well known that death is rarely due to uncontrolled lupus episodes but rather attributable to side effects of treatments in the late course of SLE. 35 This association showed a possible synergy between the effects of SLE and comorbidity, which suggests that treatment of comorbidities should be considered an integral part of clinical care for patients with SLE. Successful treatment of comorbidity would reduce the mortality attributable to comorbidity itself, and perhaps also the mortality attributable to the synergy between comorbidity and SLE.…”

Variation in initial kidney replacement therapy for end‐stage renal disease due to lupus nephritis in the United States

“…Lupus patients with recurrent infections, malignancies, or other pre-existing comorbidities may be poor candidates for PD or pre-emptive transplantation due to increased complication rates 7, 9, 10 . A recent survival analysis of LN ESRD undergoing PD revealed that pre-dialysis SLE activity scores had limited prognostic value but preexisting comorbidities, especially cardiovascular conditions, were associated with significantly higher mortality rates among SLE PD patients 9 .…”

“…It remains unclear whether long-term outcomes among LN ESRD patients differ according to the kidney replacement option chosen, in particular the two dialysis modalities 6–8 . Although there is a paucity of prospective data comparing infection rates among LN ESRD patients receiving HD compared to PD, a few studies have suggested an increased risk for peritonitis and higher mortality rates among SLE patients receiving PD 7, 9, 10 . Past studies of the influence of dialysis modality upon SLE disease activity have also yielded inconsistent results 7–13 .…”

“…Past studies of the influence of dialysis modality upon SLE disease activity have also yielded inconsistent results 7–13 . Pre-dialysis comorbidities, especially cardiovascular conditions, have been associated with increased mortality rates among LN ESRD PD patients in particular 9 . LN ESRD patients appear to do well after kidney transplant, however, with low SLE activity and rates of recurrent lupus nephritis 14–17 .…”