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      Activity of Systemic Lupus Erythematosus in End-Stage Renal Disease Patients: Study in a Brazilian Cohort

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          Background: Dialysis has been associated with lupus remission. We studied the prevalence of systemic lupus erythematosus (SLE) as a cause of end-stage renal disease (ESRD) in the metropolitan area of Rio de Janeiro and assessed disease activity in SLE patients on dialysis. Methods: Of 3,535 ESRD patients, 63 had SLE (1.8%). Fifty-seven entered the study (54 females, 3 males, 38 ± 10 years). Hemodialysis consisted of 3 sessions per week of about 4 h duration, blood flow of about 400 ml/min, bicarbonate dialysate ([Ca<sup>2+</sup>] = 2.5–3.5 mEq/l) at 500 ml/min and cellulose acetate or polysulfone dialyzers. Activity was initially defined as: non-renal (nr) SLE disease activity index (SLEDAI) of >0; use of at least 20 mg/day of prednisone; and/or any dose of another activity-controlling drug. Fifty-seven ESRD patients without SLE were used as controls. Results:Eighteen SLE patients were under drug treatment; of the remaining, 30 had an nrSLEDAI of >0 totaling 48 patients (84%) initially labeled as active. An apparent activity was also present in 21 controls (37%). Of those, 19 had an nrSLEDAI of <4. With a cutoff of ≧4, figures in each group would be 49 and 4%. Under this criterion, age was the only significant predictor of flare in our SLE ESRD population in a multivariate logistic regression model. Activity remained high in patients who were on dialysis for >5 years (7/18, 39%). Conclusion: SLE accounted for 1.8% of our ESRD patients. Application of SLEDAI to dialysis patients may require consideration of confounding factors related to the ESRD state. Even with a score of ≧4 as a cutoff, SLE activity in dialysis patients was high (49%) and long-lasting. Age was the major determinant of flare.

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          Most cited references 13

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          Dialysis therapy.

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            Changes in the incidence of end-stage renal disease due to lupus nephritis, 1982-1995.

             M Ward (2000)
            The availability of more effective treatments for severe lupus nephritis may have influenced the rate at which end-stage renal disease (ESRD) develops in these patients.
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              Systemic lupus erythematosus: analysis of disease activity in 55 patients with end-stage renal failure treated with hemodialysis or continuous ambulatory peritoneal dialysis


                Author and article information

                Am J Nephrol
                American Journal of Nephrology
                S. Karger AG
                December 2005
                09 November 2005
                : 25
                : 6
                : 596-603
                aNephrology Division, Department of Medicine, Universidade Federal Fluminense, Niterói; bRheumatology Division, Hospital Municipal da Lagoa, Lagoa; cClínica de Doenças Renais, Niterói, and dDepartment of Statistics, Mathematical Institute, Universidade Federal Fluminense, Niterói, Brazil
                89708 Am J Nephrol 2005;25:596–603
                © 2005 S. Karger AG, Basel

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                Page count
                Figures: 1, Tables: 9, References: 25, Pages: 8
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                Original Report: Patient-Oriented, Translational Research


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