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Systemic Lupus Erythematosus in Hemodialysis: Survival Comparison and Mortality-Related Factors
1Division of Rheumatology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu 42472, Republic of Korea.
Insights
Systemic lupus erythematosus (SLE) patients on hemodialysis (HD) showed better survival than those with diabetes mellitus (DM) and comparable survival to other diseases. Key survival factors for SLE patients on HD include age, comorbidity index, hemoglobin, creatinine, and blood pressure.
Area of Science:
- Nephrology
- Rheumatology
- Epidemiology
Background:
- Systemic lupus erythematosus (SLE) is a complex autoimmune disease.
- End-stage renal disease (ESRD) often requires hemodialysis (HD).
- Outcomes for SLE patients on HD compared to other common conditions are not well-established in the Korean population.
Purpose of the Study:
- To compare the survival rates of hemodialysis (HD) patients with systemic lupus erythematosus (SLE) against those with diabetes mellitus (DM) and other diseases.
- To identify factors influencing the survival of SLE patients undergoing maintenance HD.
Main Methods:
- Retrospective analysis of a national HD quality assessment program and claims data.
- Inclusion of maintenance HD patients aged 18 years and older.
- Categorization into three groups: SLE (n=569), DM (n=24,665), and others (n=31,004).
Main Results:
- Kaplan-Meier survival analysis indicated better survival in the SLE group compared to DM and other disease groups.
- Multivariate analysis revealed a hazard ratio of 1.32 (p=0.015) for the DM group versus the SLE group.
- In SLE patients on HD, age, Charlson Comorbidity Index (CCI), hemoglobin, serum creatinine, and systolic blood pressure (SBP) were significantly associated with survival.
Conclusions:
- Hemodialysis patients with SLE demonstrate superior survival compared to those with DM and comparable survival to patients with other non-SLE/DM conditions.
- Age, CCI, hemoglobin, serum creatinine, and SBP are critical prognostic factors for SLE patients undergoing hemodialysis.
Abstract:
Background and Objectives: We aimed to evaluate the outcome of systemic lupus erythematosus (SLE) patients undergoing hemodialysis (HD) by comparing the survival among HD patients with SLE, diabetes mellitus (DM), or other diseases in the Korean population. We also analyzed the factors affecting the survival of SLE patients undergoing HD. Materials and Methods: This retrospective study analyzed laboratory data from a national HD quality assessment program and claims data. The programs included maintenance HD patients aged ≥18 years. The patients were divided into three groups according to underlying comorbidities as follows: SLE (n = 569), DM (n = 24,665), and others (n = 31,004). Results: The Kaplan-Meier curve showed that the SLE group had better survival than the other two groups. Multivariate analysis showed that the hazard ratios were 0.89 (p = 0.334) in the others group and 1.32 (p = 0.015) in the DM group compared to those in the SLE group. In the SLE group, age, the Charlson Comorbidity Index (CCI) score, hemoglobin, serum creatinine levels, and systolic blood pressure (SBP) were associated with patient survival. Conclusions: This study showed that HD patients with SLE had better patient survival than those with DM and comparable survival with those with other diseases, except SLE or DM. In addition, age, CCI score, hemoglobin, serum creatinine level, and SBP were associated with survival in HD patients with SLE.
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