Poor prognosis of end-stage renal disease in systemic lupus erythematosus: a                 cohort of Chinese patients

Lee, Po‐Tsang; Fang, Hua; Chen, Chien Liang; Chiou, Yee Hsuan; Chou, Kang Ju; Chung, Hsiao Min

doi:10.1191/0961203303lu474oa

Cited by 31 publications

(25 citation statements)

References 19 publications

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“…The impairment of polymorphonuclear leukocyte phagocytosis in dialysis patients is aggravated in SLE patients receiving immunosuppressive agents [13] . In SLE patients on dialysis, infection was the major cause of mortality in a study by Lee et al [3] . In our SLE dialysis patients, however, HD and PD patients did not differ in the use of immunosuppressive medications (75.0 vs. 79.2%, p = 0.757).…”

Section: Discussionmentioning

confidence: 98%

“…The survival rate of lupus patients on dialysis is comparable to that of non-SLE dialysis patients. Lee et al [3] and Krane et al [4] documented the poor prognosis of SLE dialysis patients but did not compare clinical outcome between different dialysis modalities. In the papers by Rietveld and Berden [5] , Mojcik and Klippel [6] and Goo et al [7] , the conclusions were that treatment of lupus patients with hemodialysis (HD) has comparable results as in non-lupus patients.…”

Section: Introductionmentioning

confidence: 99%

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Peritoneal Dialysis and Hemodialysis in Systemic Lupus Erythematosus Patients: Comparison of Clinical Outcomes

Weng¹,

Hsu²,

Yu³

et al. 2009

Kidney Blood Press Res

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Background: This study compared peritoneal dialysis (PD) and hemodialysis (HD) outcomes between female systemic lupus erythematosus (SLE) patients with end-stage renal disease (ESRD) due to lupus nephropathy. Methods: 22 female SLE patients undergoing PD were compared with 14 female SLE patients receiving HD. Clinical outcomes and infective complications were reviewed. Results: The overall mortality rate was much higher in the PD group (6/22) than in the HD group (1/14) (p = 0.027). PD patients had higher C-reactive protein level (37.1 ± 41.4 vs. 6.7 ± 9.5 mg/l, p = 0.037) and numbers of infectious episode (PD vs. HD: 1 episode per 33.16 patient-months vs. 1 episode per 118.26 patient-months, respectively, p = 0.046). Before the end of the observation period, HD patients had higher serum albumin (3.8 ± 0.2 vs. 3.3 ± 0.6 g/dl, p = 0.01). Conclusions: In female SLE patients with ESRD due to lupus nephropathy, clinical outcomes are better after undergoing HD than after undergoing PD.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Peritoneal Dialysis and Hemodialysis in Systemic Lupus Erythematosus Patients: Comparison of Clinical Outcomes

Weng¹,

Hsu²,

Yu³

et al. 2009

Kidney Blood Press Res

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“…In the last years, studies have been published showing the persistence of lupus activity in patients undergoing maintenance dialysis. Krane et al [11] reported an increase in the incidence of flares and recently Goo et al [13] and Lee et al [16] also pointed to persistent serological activity in patients on chronic dialysis.…”

Section: Discussionmentioning

confidence: 99%

“…We opted for a cross-sectional study that, in contrast with others [2,7,8,9, 16, 17], included a control group. The system used to assess disease activity was the SLEDAI due to its easy applicability and previous use in studies evaluating ESRD patients [18,19,20,21].…”

Section: Discussionmentioning

confidence: 99%

“…In a more recent study with 45 SLE patients but without controls [13], patients’ activity measured by SLEDAI did not decrease along with attendance which was, on average, 53 months. In another recent study, which enrolled 26 Chinese patients from before the beginning of ESRD [16], clinical activity tended to diminish with time on dialysis. Interestingly, the 5- and 10-year survivals among SLE patients were lower than in the ESRD population allowing one to think that interventions may be necessary to change the results.…”

Section: Discussionmentioning

confidence: 99%

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Activity of Systemic Lupus Erythematosus in End-Stage Renal Disease Patients: Study in a Brazilian Cohort

et al. 2005

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Background: Dialysis has been associated with lupus remission. We studied the prevalence of systemic lupus erythematosus (SLE) as a cause of end-stage renal disease (ESRD) in the metropolitan area of Rio de Janeiro and assessed disease activity in SLE patients on dialysis. Methods: Of 3,535 ESRD patients, 63 had SLE (1.8%). Fifty-seven entered the study (54 females, 3 males, 38 ± 10 years). Hemodialysis consisted of 3 sessions per week of about 4 h duration, blood flow of about 400 ml/min, bicarbonate dialysate ([Ca²⁺] = 2.5–3.5 mEq/l) at 500 ml/min and cellulose acetate or polysulfone dialyzers. Activity was initially defined as: non-renal (nr) SLE disease activity index (SLEDAI) of >0; use of at least 20 mg/day of prednisone; and/or any dose of another activity-controlling drug. Fifty-seven ESRD patients without SLE were used as controls. Results:Eighteen SLE patients were under drug treatment; of the remaining, 30 had an nrSLEDAI of >0 totaling 48 patients (84%) initially labeled as active. An apparent activity was also present in 21 controls (37%). Of those, 19 had an nrSLEDAI of <4. With a cutoff of ≧4, figures in each group would be 49 and 4%. Under this criterion, age was the only significant predictor of flare in our SLE ESRD population in a multivariate logistic regression model. Activity remained high in patients who were on dialysis for >5 years (7/18, 39%). Conclusion: SLE accounted for 1.8% of our ESRD patients. Application of SLEDAI to dialysis patients may require consideration of confounding factors related to the ESRD state. Even with a score of ≧4 as a cutoff, SLE activity in dialysis patients was high (49%) and long-lasting. Age was the major determinant of flare.

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Disease activity in systemic lupus erythematosus patients with end-stage renal disease: systematic review of the literature

Mattos

Santiago

2012

Clin Rheumatol

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It is not unusual that patients with systemic lupus erythematosus (SLE) progress to terminal renal failure and subsequently require renal replacement therapy. Previous studies have shown that clinical and/or serological remission in patients with SLE is common in those who develop end-stage renal disease (ESRD). On the other hand, the persistence of lupus activity among patients undergoing long-term dialysis is not rare, either. The aim of this study is to define, by means of a systematic review, the course of SLE activity in patients who developed ESRD. Data were obtained through searches for articles in the MEDLINE (1966 to 2011), SCielo, and LILACS databases, using the following keywords: "chronic renal failure", "systemic lupus erythematosus", "end-stage renal disease", "lupus activity", "disease activity", "lupus flare", "hemodialysis", and "renal replacement therapy" and their corresponding translations in Portuguese. Twenty-four articles were found which evaluated the degree of lupus activity in patients with ESRD. Fifteen of these studies spoke of a substantial reduction of clinical and/or serological activity after the development of ESRD, while nine articles found that the amount of clinical and/or serological activity was similar to that of the phase prior to terminal renal failure, or it occurred in at least 50% of the patients studied. Although the majority of studies showed that lupus flares tend to decrease in frequency in patients who develop ESRD, in this scenario, one should be prepared to correctly diagnose a recurrence of the disease, as well as to perform appropriate therapy.

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Poor prognosis of end-stage renal disease in systemic lupus erythematosus: a cohort of Chinese patients

Cited by 31 publications

References 19 publications

Peritoneal Dialysis and Hemodialysis in Systemic Lupus Erythematosus Patients: Comparison of Clinical Outcomes

Peritoneal Dialysis and Hemodialysis in Systemic Lupus Erythematosus Patients: Comparison of Clinical Outcomes

Activity of Systemic Lupus Erythematosus in End-Stage Renal Disease Patients: Study in a Brazilian Cohort

Disease activity in systemic lupus erythematosus patients with end-stage renal disease: systematic review of the literature

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