Long-term outcome of lupus nephritis patients treated with peritoneal dialysis

Abstract

Objective To investigate the long-term outcome of Chinese lupus nephritis (LN) patients undergoing peritoneal dialysis (PD). Methods All LN patients with end-stage renal disease(ESRD) initiating PD between May 1, 1995 and Apr 30, 2013 at Renji Hospital, Shanghai Jiao Tong University School of Medicine, China, with complete data (n=33) were enrolled. Another 33 age-, gender-and comorbidity-matched non-LN patients receiving PD were selected as the control group for the study. All patients were followed up from the date of PD initiation until death, cessation of PD, transfer to other centers or the end of this study (Dec 31, 2013). Kaplan-Meier analysis and Log-Rank test were applied to compare patient survival, technique survival and peritonitis-free survival between two groups. Results Compared to the control group, LN patients had higher eGFR, anti-dsDNA and hs-CRP level at the starting of PD. By the end of the study, in the LN group 13 (39.4%) patients died, 8 (24.2%) patients switched to hemodialysis (HD), 5(15.2%) patients transplanted and 2(6.1%) patients transferred to other centers. Infection was the most common cause of death in the LN group (9 patients, 69.2%), and majority of death was caused by PD-related peritonitis (6 patients, 46.2%), while cardiovascular disease (CVD) was the leading cause of death in the control group (5 patients, 83.3%). Kaplan-Meier analysis showed that LN patients had significantly lower patient survival (χ2=8.455,P= 0.004). For both LN group (6 patients, 75.0%) and control group (4 patients, 66.7%), peritonitis was the leading cause of transfer to HD. Compared to the control group, LN patients had significantly lower technique survival (χ2=6.753,P=0.009). Peritonitis rates were 1 episode/20.5 patient-months in the LN group and 1 episode/67.6 patient-months in the control group respectively. LN patients had significantly shorter peritonitis-free survival (χ2=8.256,P=0.004) when compared to their counterparts in the control group. Conclusion LN patients with ESRD receiving PD have inferior clinical outcome. Peritonitis is the most common cause of death and technique failure in LN patients. Key words: Peritoneal dialysis; Lupus nephritis; Peritonitis