Survival of lupus patients on dialysis: a Brazilian cohort

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Abstract

Objective. Data about the survival rate of lupus patients on dialysis is controversial. The objective of this controlled prospective study was to report the survival of SLE patients undergoing dialysis and to analyse factors associated with mortality.

Methods. Twenty dialysis centres were visited between May 2003 and February 2004. Disease activity was evaluated using the SLEDAI without the renal-related parameters [non-renal (nr)SLEDAI] data collection was performed at entrance to the study. The control group consisted of haemodialysis patients without SLE matched for gender, age, dialysis modality, time on dialysis and dialysis-associated HCV infection. Patients were prospectively followed for 60 months. The Kaplan–Meier method was used to estimate survival. Associations of risk factors with mortality were tested using the Cox proportional hazards model.

Results. Each group was composed of 57 patients. In the multivariate analysis, only nrSLEDAI > 8 [hazard ratio (HR) 6.368; 95% CI 1.798, 22.548; P = 0.004], and urea reduction ratio (HR 0.953; 95% CI 0.917, 0.990; P = 0.014) were independently associated with mortality in lupus patients. The 5-year survival rate of the control group and the one from SLE patients with nrSLEDAI ≤ 8 (n = 51) were similar (83% and 73%, respectively) but significantly better than the one for SLE patients with nrSLEDAI > 8 (n = 6, 17%), P < 0.001.

Conclusion. A high nrSLEDAI was strongly associated with 5-year mortality in lupus patients on dialysis.

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