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The Evolution of Lupus Activity among Patients with End-Stage Renal Disease Secondary to Lupus Nephritis

Authors
 Young Suck Goo  ;  Hyeong Cheon Park  ;  Kyu Hun Choi  ;  Dae Suk Han  ;  Ho Yung Lee  ;  Ki Il Park  ;  Yu Seun Kim  ;  Soon Il Kim  ;  Shin Wook Kang  ;  Soo Kon Lee  ;  Yong Beom Park  ;  Beom Seok Kim  ;  Hoon Young Choi 
Citation
 YONSEI MEDICAL JOURNAL, Vol.45(2) : 199-206, 2004 
Journal Title
 YONSEI MEDICAL JOURNAL 
ISSN
 0513-5796 
Issue Date
2004
MeSH
Adult ; Disease Progression ; Female ; Humans ; Kidney Failure, Chronic/mortality* ; Kidney Failure, Chronic/physiopathology* ; Lupus Nephritis/mortality* ; Lupus Nephritis/physiopathology* ; Male ; Survival Analysis
Keywords
Systemic lupus erythematosus ; lupus disease activity ; end-stage renal disease
Abstract
The aim of this study was to evaluate the evolution of lupus activity in end-stage renal disease (ESRD) patients due to lupus nephritis and to determine the long-term prognosis. We reviewed the clinical courses of 45 patients with ESRD due to systemic lupus erythematosus (SLE). We analyzed the course of SLE following the onset of ESRD, with special attention to the clinical and serological manifestations, survival time on dialysis, and renal transplantation outcome. Disease activity was measured using the SLE Disease Activity Index (SLEDAI). Of the 45 patients, 21 patients were being treated with hemodialysis (HD), 11 were undergoing peritoneal dialysis (PD), and 13 underwent transplantation. Duration of follow- up was 53 ± 29 months. The SLEDAI score on commencement of renal replacement therapy was not significantly different among the 3 groups (HD: 4.2 ± 4.2, PD: 4.3 ± 2.3, Transplant: 3.2 ± 1.9). However, disease activity scored by follow-up maximal SLEDAI during dialysis or transplantation showed a significant increase after peritoneal dialysis (HD: 5.0 ± 3.6, PD: 7.4 ± 3.7, Transplant: 2.2 ± 1.7, p < 0.05). When the individual changes in the maximal SLEDAI score were considered, a significant increase was apparent after peritoneal dialysis (p < 0.05), but not after either hemodialysis or renal transplantation. There was no significant difference in cumulative survival rate, and also in technique or graft survival rates of the 3 groups. Among the variables tested, follow-up maximal SLEDAI score was the only significant factor associated with patient survival (odds ratio: 1.15, p < 0.05). The incidence (36% versus 19%) of high disease activity was greater, but not significantly, in the peritoneal dialysis group, as compared to the hemodialysis group. Clinical activity of SLE was apparent in 65% of patients in the first year of dialysis, but none showed any activity after the third year of dialysis. We found that although lupus disease activity declined after patients progressed to ESRD, lupus disease activity still affected patients' survival. An incremental increase in postdialysis lupus activity was not uncommon, especially during the first one year of dialysis. During the follow-up period, maximal SLEDAI score increased significantly after peritoneal dialysis. However, the long-term prognosis was not significantly different according to the treatment modality.
Files in This Item:
T200401390.pdf Download
DOI
10.3349/ymj.2004.45.2.199
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Goo, Young Suck(구영석)
Kim, Beom Seok(김범석) ORCID logo https://orcid.org/0000-0002-5732-2583
Kim, Soon Il(김순일) ORCID logo https://orcid.org/0000-0002-0783-7538
Kim, Yu Seun(김유선) ORCID logo https://orcid.org/0000-0002-5105-1567
Park, Ki Il(박기일)
Park, Yong Beom(박용범)
Park, Hyeong Cheon(박형천) ORCID logo https://orcid.org/0000-0002-1550-0812
Lee, Soo Kon(이수곤)
Lee, Ho Yung(이호영)
Choi, Kyu Hun(최규헌) ORCID logo https://orcid.org/0000-0003-0095-9011
Choi, Hoon Young(최훈영) ORCID logo https://orcid.org/0000-0002-4245-0339
Han, Dae Suk(한대석)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/112566
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