Background Ten to twenty-five percent of systemic lupus erythemathosus (SLE) patients will progress to end-stage renal disease (ESRD). Data about the survival rate of lupus patients on dialysis is controversial.
Objectives The present study reports the survival of SLE patients undergoing dialysis and analyzes factors associated with mortality.
Methods Twenty dialysis centers were visited between May/2003 and February/2004. Disease activity was evaluated using the SLE disease activity index (SLEDAI) without the renal related parameters (nrSLEDAI); Clinical examination and laboratory tests were performed at entrance in the study. The control group consisted of hemodialysis patients without SLE, matched for gender, race, age, time on dialysis, and hepatitis C virus (HCV) infection. Patients were followed for 60 months. The end-point was death of any cause. Kaplan-Meier method was used to estimate survival. Associations of risk factors with mortality were tested with the Cox proportional hazards model.
Results Each group was composed of 57 patients. The group of SLE tended to have a slightly shorter time on dialysis (54±50 months vs. 71±53 months, P=0.0829). Twelve patients (21%) in each group had HCV infection. The prevalence of flare in SLE patients approached 44%. The 1- and 5-year survival rates of SLE patients and controls were 88 and 70%, 93 and 84%, respectively. When analyzing the Kaplan Meier curves, survival of the control group and the one from SLE patients with nrSLEDAI ≤8 were similar but significantly better than the one of SLE patients with nrSLEDAI>8 (P<0.001). In the univariate analysis, only nrSLEDAI (either as a continuous or a categorical variable, HR 1.176, 95%CI 1.043-1.326, P=0.008, and HR 5.746, 95%CI 1.983-16.651, P=0.001, respectively), immunosuppressive use (HR 2.713, 95%CI 1.032-7.133, P=0.043), and URR (HR 0.967, 95% CI 0.930-1.005, P=0.086) were significantly associated with mortality. In the multivariate analysis, only nrSLEDAI>8 (HR 6.368, 95%CI 1.798-22.548, P=0.004), and URR (HR 0.953, 95%CI 0.917-0.990, P=0.014) emerged as independent factors associated with mortality in lupus patients.
Conclusions A high nrSLEDAI was strongly associated with five year mortality in lupus patients on dialysis.
Disclosure of Interest None Declared
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