Y.E. Kim, MD, S.M. Ahn, MD, Y.G. Kim, MD, PhD, C.K. Lee, MD, PhD, B. Yoo, MD, PhD, and S. Hong, MD, PhD, Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul.
S.J. Choi, MD, D.H. Lim, MD, PhD, Department of Rheumatology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan.
J Rheumatol. 2022 Oct;49(10):1131-1137. doi: 10.3899/jrheum.220101. Epub 2022 Aug 15.
Although systemic lupus erythematosus (SLE) disease activity diminishes after starting dialysis, flares have been documented during dialysis. Hence, we studied the various clinical and therapeutic variables of patients with SLE who had a disease flare while on dialysis.
The medical records of patients with SLE who received dialysis at 2 tertiary referral hospitals in South Korea were reviewed. The disease activity was analyzed in terms of the nonrenal SLE Disease Activity Index (SLEDAI), and the factors associated with SLE flares were evaluated.
Of the total of 121 patients with SLE on dialysis, 96 (79.3%) were on hemodialysis (HD) and 25 (20.7%) were on peritoneal dialysis (PD). During a median follow-up of 45 months (IQR 23-120) after the initiation of dialysis, 32 (26.4%) patients experienced an SLE flare (HD, n = 25; PD, n = 7). The most common features of SLE flare were hematologic (40.6%; thrombocytopenia [31.2%] and leukopenia [21.8%]) and constitutional manifestations (40.6%). Fever was the most common (34.3%) feature among the constitutional symptoms. Treatments for disease flares were based on corticosteroids, and 11 (34.3%) patients required additional immunosuppressants, including cyclophosphamide and mycophenolate mofetil. Nonrenal SLEDAI score before dialysis initiation (HR 1.24, 95% CI 1.12-1.36; = 0.001) was a significant risk factor for disease flare during dialysis.
More than a quarter of the patients with SLE experienced a disease flare during dialysis, which most commonly had hematologic manifestations, particularly thrombocytopenia. Continued follow-up and appropriate treatments, including immunosuppressants, should be considered for patients with SLE receiving dialysis.
尽管系统性红斑狼疮（SLE）患者在开始透析后疾病活动度会降低，但已有在透析期间出现疾病发作的记录。因此，我们研究了在韩国 2 家三级转诊医院接受透析的 SLE 患者的各种临床和治疗变量，这些患者在透析期间出现了疾病发作。
回顾了在韩国 2 家三级转诊医院接受透析的 SLE 患者的病历。根据非肾脏 SLE 疾病活动指数（SLEDAI）分析疾病活动度，并评估与 SLE 发作相关的因素。
在总共 121 名接受透析的 SLE 患者中，79.3%（96 名）接受血液透析（HD），20.7%（25 名）接受腹膜透析（PD）。在开始透析后的中位随访 45 个月（IQR 23-120）期间，32 名（26.4%）患者出现 SLE 发作（HD，n=25；PD，n=7）。SLE 发作最常见的特征是血液学（40.6%；血小板减少症[31.2%]和白细胞减少症[21.8%]）和全身表现（40.6%）。发热是全身症状中最常见的（34.3%）特征。疾病发作的治疗基于皮质类固醇，11 名（34.3%）患者需要额外的免疫抑制剂，包括环磷酰胺和霉酚酸酯。透析前非肾脏 SLEDAI 评分（HR 1.24，95%CI 1.12-1.36； = 0.001）是透析期间疾病发作的显著危险因素。
超过四分之一的 SLE 患者在透析期间出现疾病发作，最常见的是血液学表现，特别是血小板减少症。对于接受透析的 SLE 患者，应考虑进行持续随访和适当的治疗，包括免疫抑制剂。
