Poor prognosis in end-stage lupus nephritis due to nonautologous vascular access site associated septicemia and lupus flares.
A poor prognosis was observed in patients who had end-stage renal disease (ESRD) as a result of systemic lupus erythematosus (SLE). This was true even in patients in whom SLE disease activity was transiently quiescent during the period of hemodialysis. Six of 9 patients with ESRD and SLE died with active SLE and/or sepsis 1-28 months following the onset of dialysis. In 5 of the 6 patients, acute inflammatory activity of SLE flared within 1 month of the patient's death. Four patients died with superimposed sepsis, but only 2 of the 4 were receiving high-dose concomitant immunosuppressives for more than 1 week prior to death. Infected hemodialysis vascular access sites were implicated as the source of septicemia in 3 of 4 infectious deaths. The 3 surviving patients had minimal lupus activity prior to the development of ESRD, a possible marker for stability in SLE patients who require hemodialysis. Our results suggest that hemodialyzed lupus patients with nonautologous vascular access sites may be at continued increased risk for life-threatening inflammatory and septic complications.
Sires
R L
RL
Department of Medicine, Harbor-UCLA Medical Center, Torrance.
Adler
S G
SG
Louie
J S
JS
Cohen
A H
AH
D000328:Adult; D001424:Bacterial Infections / Q000150:complications* / Q000188:drug therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology*; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy; D008181:Lupus Nephritis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D006435:Renal Dialysis; D018805:Sepsis / Q000150:complications* / Q000188:drug therapy; D013997:Time Factors
D003520:Cyclophosphamide; D011241:Prednisone