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Le malattie immunitarie aumentano il rischio di complicanze infettive?
Gianfranca Cabiddu
Divisione Nefrologia Azienda Ospedaliera Brotzu- Cagliari
SYSTEMIC LUPUS ERYTHEMATOSUS AND PERITONEAL DIALYSIS: OUTCOMES AND
INFECTIOUS COMPLICATIONS
Huang JW
Perit Dial Int 2001; 21: 143 -147
Clinical outcomes of systemic lupus erythematosus patients undergoing continous ambulatory peritoneal dialysis Siu YP
Nephrol Dial Transplant (2005); 20: 2797-2802
Infectious complications and outcome in lupus patients with ESRF treated with CAPD Huang et al.(2001) Siu et al.
(2005) SLE Controls SLE Controls Males/females (
n
) 3/20 6/40 5/13 10/26 Age (years) 33.9 ± 7.6 34.3 ± 7.4 40.8
± 10.3 42.2
± 7.3
± 24.0 47.3
± 35.3 35.4
± 20.7 36.7
± 28.2
(months) Albumin (g/dl) 31.6 ±
I
35.4
± 5.6
5.0
35.2 ± 5.0 30.4
± 6.6
56.5 ? 88.8 5.5 at start of PD (%) Peritonitis 0.38
0.18 0.68
0.28
Exit-site infections 0.24
0.12 0.24 0.20
Other infections ? ? 0.80
0.13
Outcomes of Peritoneal Dialysis Patients with Systemic Lupus Erythematosus (SLE) Versus Gender- and Age-Matched Control Group
SLE Control Outcome Remain on PD
Dropped out, due to:
Peritonitis Transplant Death Sepsis Lupus encephalitis Intracerebral hemorrhage Cardiovascular event (n =23)
5 (22%)
(n =46)
25 (54%)
8 (35%)
1 (4%) 8 (35%) 5
4 (9%)
9 (20%) 5 (11%) 2 1 1 0 1 1 2 Huang- Perit Dial Int 2001; 21: 143-147
Total number of episodes and type of infective complications
Types of infective complications value
Total n° of episodes
(mean episodes per 100 patient-months)
P SLE group CGn group Peritonitis 40 (5.7±1.64) 37 (2.37±0.58) 0.02
Dialysis catheter exit site infection 16 (1.88±0.87) 14 (1.69±0.68) 0.87
Respiratory (pneumonia) 23 (3.25±1.08) 4 (0.38±0.21) 0.001
Cutaneous (cellulitis, subcutaneous abscess) 3 (1.08±0.68) 3 (0.15±0.09) 0.06
Gastrointestinal (gastroenteritis) 5 (1.59±0.89) 4 (0.26±0.15) 0.047
Cardiovascular (pericarditis, endocarditis) 4 (0.54±0.31) 0 (0) 0.014
Genitourinary (urinary tract infection, epididymo-orchitis, vaginitis 1 (0.09±0.09) 4 (0.28±0.14) 0.37
Skeletal (tuberculosis of spine) 0 (0) 1 (0.03±0.03) 0.32
Sui YP
Nephrol Dial Transplant (2005) 20: 2797 –2802
SYSTEMIC LUPUS ERYTHEMATOSUS AND PERITONEAL DIALYSIS: OUTCOMES AND
INFECTIOUS COMPLICATIONS
Huang JW
Perit Dial Int (2001)
SLE patients who tapered off steroid therapy after
commencing PD had a lower incidence of peritonitis than the other patients remaining on steroid therapy.
Original Article
Impaired outcome of continuous ambulatory peritoneal dialysis in immunosuppressed patients
P. A. Andrews, K. J. Warr, J. A. Hicks and J. S. Cameron
Nephrol Dial Transplant (1996); 11: 1104-1108
The peritonitis frequency in the immunosuppressed
patients was 1,8 episodes/patient-year and in those
without immunosuppression 0,68 (P<0,01).
Original Article
Impaired outcome of continuous ambulatory peritoneal dialysis in immunosuppressed patients
P. A. Andrews, K. J. Warr, J. A. Hicks and J. S. Cameron
Nephrol Dial Transplant (1996); 11: 1104-1108
Immunosuppression is an important risk factor for CAPD peritonitis.
CAPD may not be the initial therapy of choice in this high-risk group .
Infectious complications and outcome in lupus patients with ESRF treated with CAPD Huang et al.
Siu et al.
SLE Controls SLE Controls Males/females (
n
) 3/20 6/40 5/13 10/26 Age (years) 33.9
± 7.6 34.3
± 7.4 40.8
± 10.3 42.2
± 7.3
± 24.0 47.3 ± 35.3 35.4
± 20.7 36.7
± 28.2
(months)
Albumin (g/dl) 31.6
±
5.0
∗
35.2
±
5.0 30.4
±
6.6
∗ at start of PD (%)
Peritonitis 0.38
+ Exit-site infections 0.24
∗
0.18 0.68
Other infections ? ? 0.80
∗ ∗ P<0,01 P<0,02 + P<0,0001
§
0.28
0.12 0.24 0.20
0.13
§
Nephrol Dial Transplant (2008) 23: 3056 – 3060
Editorial Review
Renal replacement therapy in lupus
nephritis Anke Rietveld and Jo H. M.
Berden
results as in non lupus patients. In contrast, during CAPD treatment, peritonitis and other infectious complications are more frequent in lupus patients.
Therefore, haemodialysis is preferred over CAPD, especially if
the patient is still using immunosuppressives.