Systemic lupus erythematosus and peritoneal dialysis: Outcomes and infectious complications

Objective: Systemic lupus erythematosus (SLE) is the most common secondary glomerulonephritis resulting in end-stage renal disease (ESRD) among young adults in Taiwan. Studies of the infectious complications and outcomes amon g such SLE patients undergoing peritoneal dialysis (PD) are limited. Design: A retrospective age- and gender-matched case control study. Setting: A university teaching hospital. Patients: There were 23 SLE patien ts with ESRD receiving PD for more than 3 months during the past 15 years. Another 45 age- and gender-matched non-SLE nondiabetic patients receiving P D were selected as the control group in this study. Intervention: All patients underwent Po as renal replacement therapy and we re regularly followed up at this hospital. Main Outcome Measures: Technique survival and incidences of exit-site infec tion (ESI) and peritonitis in these patients. Results: The SLE patients had a lower predialysis serum albumin than the co ntrol group (3.16 +/- 0.50 g/dL vs 3.52 +/- 0.50 g/dL, p< 0.01). The incide nces of exit-site infection (ESI) and peritonitis were higher for SLE patie nts than for control patients (p < 0.01 and p < 0.001, respectively). Kapla n-Meier survival analysis indicated that SLE patients had shorter time inte rvals to first infectious complications, and poorer technique survival. Inf ection was the major cause of dropout and mortality in the SLE patients. Th e SLE patients had a reduced chance of receiving a renal transplant. The us e of steroids by SLE patients was associated with a higher incidence of per itonitis (p = 0.04), but association with ESI was insignificant. In a Cox r egression model, the underlying SLE was the only risk factor for technique failure and time interval to first infectious complication. Conclusion: SLE patients undergoing PD are more susceptible to infection th an age- and gender-matched non-SLE nondiabetic patients and have poorer tec hnique survival. Systemic lupus erythematosus itself may further compromise the immunity of uremic patients.