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

Abstract

We studied the clinical course of 26 systemic lupus erythematosus(SLE) patients who started regular dialysis at our hospital and whose stay exceeded a three-month duration in order to investigate the long-term prognosis in a Chinese cohort. Clinical and serological activities of lupus before and after dialysis were analysed. To compare the long-term survival rate, controls were set using 78 age-matched end-stage renal disease (ESRD) patients who did not have SLE or diabetes mellitus and entered the chronic dialysis program at a similar period with SLE dialysis patients. There was a significant decrease in clinical lupus activity after starting regular dialysis (P < 0.05); however, the serologicalactivity remained the same. The five-and ten-yearsurvivalrates were significantly lower in the SLE patients (73 and 38% in the SLE group versus 95 and 88% in the non-SLE group, P < 0.05). SLE patients had a 4.3-times higher risk of death than non-SLE patients (P < 0.05, 95% confidence interval,1.2-15.2). Also, the deceased SLE patients had persistent lower serum levels of complement 3. SLE patients with ESRD remain clinically quiescent despite persistent serological abnormalities and have a worse prognosis than other uremia patients in the Chinese population.

Keywords

dialysis end-stage renal disease lupus nephritis mortality systemic lupus erythematosus

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References

Austin HA 3rd , Meunz LR , Joyce KM et al. Prognostic factors in lupus nephritis: contribution of renal histologic data . Am J Med 1983; 75: 382-391 .

Goulet JR , Mackenzie T , Levinton C , Hayslett JP , Ciampi A , Esdaile JM. The longterm prognosis of lupus nephritis: the impact of disease activity . J Rheumatol 1993; 20: 59-65 .

Ginzler EM , Diamond HS , Weiner M et al. A multicenter study of outcome in systemic lupus erythematosus: I. Entry variables as predictors of prognosis . Arthritis Rheum 1982; 25: 601-611 .

Fries JF , Powers R , Kempson RI. Late-stage lupus nephropathy . J Rheumatol 1974; 1: 166-175 .

Coplon NS , Diskin CJ , Petersen J , Swenson RS. The long-term clinical course of systemic lupus erythematosus in end-stage renal disease . N Engl J Med 1983; 308: 186-190 .

Jarrett MP , Santhanam S , Del Greco F. The clinical course of end-stage renal disease in systemic lupus erythematosus . Arch Intern Med 1983; 143: 1353-1356 .

Cheigh JS , Stenzel KH. End-stage renal disease in systemic lupus erythematosus . Am J Kidney Dis 1993; 21: 2-8 .

Kimberly RP , Lockshin MD , Sherman RL , Beary JF , Mouradian J , Cheigh JS. ‘End-stage’ lupus nephritis: clinical course to and outcome on dialysis. Experience with 39 patients . Medicine 1981; 60: 277-287 .

Ziff M , Helderman JH. Dialysis and transplantation in end-stage lupus nephritis . N Engl J Med 1983; 308: 218-219 .

10.

Pollock CA , Ibels LS. Dialysis and transplanation in patients with renal failure due to systemic lupus erythematosus: the Australian and New Zealand experience . Aust NZ J Med 1987; 17: 321-325 .

11.

Nissenson AR , Port FK. Outcome of end-stage renal disease in patients with rare causes of renal failure: III. Systemic/vascular disorders . Q J Med 1990; 273: 63-74 .

12.

Krane NK , Buzjak K , Archie M , O’Donovan R. Persistent lupus activity in end-stage renal disease . Am J Kidney Dis 1999; 33: 872-879 .

13.

Bombardier C , Gladman DD , Urowitz MB , Caron D , Chang CH , and the Committee on Prognosis Studies in SLE . Deviation of the SLEDAI: A disease activity index for lupus patients . Arthritis Rheum 1992; 35: 630-640 .

14.

Nossent HC , Swaak TJG , Berden JHM , for the Dutch Working Party on SLE . Systemic lupus erythematosus. Analysis of disease activity in 55 patients with end-stage renal failure treated with hemodialysis or continuous ambulatory peritoneal dialysis . Am J Med 1990; 89: 169-174 .

15.

Bruce IN , Hallett DC , Gladman DD , Urowitz MB. Extrarenal disease activity in systemic lupus erythematosus is not suppressed by chronic renal insufficiency or renal replacement therapy . J Rheumatol 1999; 26: 1490-1494 .

16.

Okano K , Yumura W , Nitta K et al. Analysis of lupus activity in end-stage renal disease treated by hemodialysis . Int Med 2001; 40: 598-602 .

17.

Pahl MV , Vaziri ND , Saiki JK , Upham T , Ness R. Chronic hemodialysis in end-stage lupus nephritis: Changes of clinical and serological activities . Int J Artif Organs 1984; 8: 423-428 .

18.

Hopkinson ND , Doherty M , Powell RJ. Clinical features and race-specific incidence/prevalence rates of systemic lupus erythematosus in a geographically complete cohort of patients . Ann Rheum Dis 1994; 53: 675-680 .

19.

Thumboo J , Uramoto K , O’Fallon WM et al. A comparative study of the clinical manifestations of systemic lupus erythematosus in Caucasians in Rochester, Minnesota, and Chinese in Singapore, from 1980 to 1992 . Arthritis Rheum 2001; 45: 494-500 .

20.

Jarrett MP , Santhanam S , Del Greco F. The clinical course of end-stage renal disease in systemic lupus erythematosus . Arch Intern Med 1983; 143: 1353-1356 .

21.

Staples PJ , Gerding DW , Decker JL , Grodon RS Jr. Incidence of infection in systemic lupus erythematosus . Arthritis Rheum 1974; 17: 1-10 .

22.

Manzi S , Meilahn EN , Rairei JE et al. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: Comparison with the Framingham Study . Am J Epidemiol 1997; 145: 408-415 .

23.

Ward MM. Premature morbidity from cardiovascular and cerebrovascular diseases in women with systemic lupus erythematosus . Arthritis Rheum 1999; 42: 338-346 .

24.

Ward MM. Cardiovascular and cerebrovascular morbidity and mortality among women with end-stage renal disease attributable to lupus nephritis . Am J Kidney Dis 2000; 36: 516-525 .