Undertreatment of disease activity in systemic lupus erythematosus patients with endstage renal failure is associated with increased all-cause mortality.
Undertreatment of disease activity in systemic lupus erythematosus patients with endstage renal failure is associated with increased all-cause mortality.
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DOI：
10.3899/jrheum.110571
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发表时间：
2011-11
期刊：
影响因子：
--
通讯作者：
Putterman C
中科院分区：
文献类型：
--
作者：
Broder A;Khattri S;Patel R;Putterman C
评估在开始肾脏替代治疗后继续进行血液流变学随访和免疫抑制治疗是否与终末期肾衰竭狼疮患者生存率增加相关。我们确定了2005年至2011年期间在城市三级护理中心开始肾脏替代治疗的所有21岁以上狼疮患者。死亡率数据是通过住院记录和社会保障死亡指数数据库获得的。我们确定了80名接受肾脏替代治疗的狼疮患者。22例患者（28%）在开始肾脏替代治疗后经常在风湿病诊所接受随访（每年2次或2次以上访视），58例患者（72%）很少接受随访（每年少于2次访视）。移植患者的存活率明显高于透析患者。然而，与开始透析后不常随访的患者相比，开始透析后频繁随访的SLE患者的4年生存率显著更高，对数秩p = 0.03。此外，在考克斯比例风险模型中，泼尼松单药治疗或不用药治疗与死亡的风险比（HR）为6.1，95% CI相关（1.1，34），p = 0.04，HR 13，95% CI（1.5，106），p = 0.02，与接受免疫抑制治疗联合或不联合泼尼松治疗的患者相比，校正了SLE诊断时的年龄、性别，移植状态和发生终末期肾衰竭后的风湿病就诊频率。在接受肾脏替代治疗的狼疮患者中，活动性疾病可能未被充分认识和治疗，导致死亡率增加。
To evaluate whether continuing rheumatology follow-up visits and immunosuppressive therapy after starting renal replacement were associated with increased survival in lupus patients with end stage renal failure. We identified all lupus patients over 21 years old who started renal replacement therapy between 2005 and 2011 at an urban tertiary care center. Mortality data was obtained using in-hospital records and the Social Security Death Index database. We identified 80 lupus patients on renal replacement therapy. Twenty two patients (28%) were followed in rheumatology clinics frequently (2 or more visits per year) after starting renal replacement therapy, and 58 patients (72%) were followed infrequently (fewer than 2 visits per year). Survival rates were significantly higher in transplant patients compared with dialysis patients. However, SLE patients followed frequently after starting dialysis had significantly higher 4-year survival rates compared with patients followed infrequently after starting dialysis, log rank p = 0.03. Furthermore, in the Cox proportional hazards model, treatment with prednisone alone or with no medication was associated with a hazard ratio (HR) of death of 6.1, 95% CI (1.1, 34), p = 0.04, and HR 13, 95% CI (1.5, 106), p = 0.02, respectively, compared with patients treated with a combination of immunosuppressive therapy with or without prednisone, adjusted for age at SLE diagnosis, gender, transplant status and the frequency of rheumatology visits after the development of end stage renal failure. Active disease in lupus patients on renal replacement therapy may be under-recognized and under-treated, leading to increased mortality.
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影响因子：
6.1
作者：
Chelamcharla, Madhukar;Javaid, Basit;Goldfarb-Rumyantzev, Alexander S.
通讯作者：
Goldfarb-Rumyantzev, Alexander S.
影响因子：
5.5
作者：
Croca, Sara C.;Rodrigues, Teresa;Isenberg, David A.
通讯作者：
Isenberg, David A.
影响因子：
--
作者：
Norby, Gudrun E.;Leivestad, Torbjorn;Holdaas, Hallvard
通讯作者：
Holdaas, Hallvard
影响因子：
--
作者：
Costenbader, Karen H.;Desai, Amrita;Alarcon, Graciela S.;Hiraki, Linda T.;Shaykevich, Tamara;Brookhart, M. Alan;Massarotti, Elena;Lu, Bing;Solomon, Daniel H.;Winkelmayer, Wolfgang C.
通讯作者：
Winkelmayer, Wolfgang C.
影响因子：
2.6
作者：
Contreras, G;Pardo, V;Estrada, HG
通讯作者：
Estrada, HG