Department of Immunology and Rheumatology and.
Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Rheumatology (Oxford). 2016 Mar;55(3):429-35. doi: 10.1093/rheumatology/kev349. Epub 2015 Sep 21.
The aim of this study was to recognize risk factors for extrarenal SLE flares in patients with end-stage renal disease (ESRD) receiving renal replacement therapy (RRT).
We performed a retrospective, case-control study in a tertiary care hospital in Mexico City from 1993 to 2014. Cases were lupus patients who had any extrarenal flare after RRT. Controls were SLE patients with ESRD but without flares. We recorded demographic features and clinical and immunological parameters. Differences between groups were analysed by Student's t-test. Association was assessed by the odds ratio (OR) and 95% CI. Multivariate analysis was performed by binary logistic regression.
Eighty-eight patients were included: 38 cases (50 flares) and 50 controls. The proportion of men was higher in cases (24 vs 8%, P = 0.029). The most common flares were haematologic (42%), mucocutaneous (38%) and articular (30%). Independent risk factors for flares included age at RRT start [OR 0.92 (95% CI 0.88, 0.96), P < 0.001], history of haematologic activity [OR 3.79 (95% CI 1.05, 13.7), P = 0.04], anti-cardiolipin IgM [OR 4.39 (95% CI 1.32, 14.6), P = 0.02] and low C4 levels [OR 9.7 (95% CI 2.49, 39.12), P = 0.001].
SLE patients continue to be at risk for extrarenal activity after RRT. The most common flare was haematologic, which correlated with the history of haematologic activity and anti-cardiolipin positivity as independent risk factors. Lower C4 levels and younger age at the beginning of RRT were also associated. Patients with these characteristics should have a closer follow-up in order to detect and treat SLE flares in a timely manner.
本研究旨在识别接受肾脏替代治疗（RRT）的终末期肾病（ESRD）患者发生肾外狼疮发作的危险因素。
我们在墨西哥城的一家三级护理医院进行了一项回顾性病例对照研究，时间为 1993 年至 2014 年。病例为 RRT 后发生任何肾外发作的狼疮患者。对照为患有 ESRD 但无发作的 SLE 患者。我们记录了人口统计学特征以及临床和免疫参数。通过 Student's t 检验分析组间差异。通过比值比（OR）和 95%CI 评估相关性。通过二元逻辑回归进行多变量分析。
共纳入 88 例患者：38 例（50 例发作）和 50 例对照。病例组中男性比例较高（24%比 8%，P = 0.029）。最常见的发作为血液学（42%）、黏膜皮肤（38%）和关节（30%）。发作的独立危险因素包括 RRT 起始时的年龄[OR 0.92（95%CI 0.88,0.96），P < 0.001]、血液学活动史[OR 3.79（95%CI 1.05,13.7），P = 0.04]、抗心磷脂 IgM[OR 4.39（95%CI 1.32,14.6），P = 0.02]和低 C4 水平[OR 9.7（95%CI 2.49,39.12），P = 0.001]。
SLE 患者在 RRT 后仍有发生肾外活动的风险。最常见的发作为血液学，这与血液学活动史和抗心磷脂阳性作为独立危险因素相关。较低的 C4 水平和 RRT 起始时的年龄较小也与狼疮发作相关。具有这些特征的患者应进行更密切的随访，以便及时发现和治疗 SLE 发作。
