ESRD Risk Higher in SLE Patients Hospitalized for Infections

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End-stage renal disease is 5-fold more likely to develop in patients with 3 or more infection-related hospitalizations versus none.
End-stage renal disease is 5-fold more likely to develop in patients with 3 or more infection-related hospitalizations versus none.

Infection-related hospitalizations are associated with a significantly higher risk of end-stage renal disease (ESRD) in patients with systemic lupus erythematosus (SLE), according to researchers. The risk is particularly elevated in patients with juvenile-onset SLE.

In a nationwide cohort study of 7326 SLE patients in Taiwan, Chien-Hung Lin, MD, of the National Yang-Ming University in Taipei, and colleagues found that patients who had 3 or more infection-related hospitalizations had a 5-fold increased risk for ESRD compared with those who experienced no infection-related hospitalizations. Among patients diagnosed with SLE before age 18 years, those with 3 or more infection-related hospitalizations had a 14-fold increased risk.

“The present study is the first attempt to investigate the risk factors for ESRD in SLE patients from a nationwide cohort in Taiwan,” Dr Lin's group reported online ahead of print in Nephrology Dialysis Transplantation.

The researchers said their findings extend those of previous studies in demonstrating an increased risk for ESRD when SLE patients are hospitalized for infection. “This suggests that clinicians should implement measures that reduce the incidence of serious infections in patients with SLE,” they wrote.

Patients with SLE have a higher risk of infection than the general population, and infection is the leading cause of mortality in these patients, followed by cardiovascular complications, the investigators noted.

“The clinical implications of our results are that serious infection has a close relationship with ESRD, a major complication of SLE, and that implementation of measures that seek to reverse the trend of infectious complications in SLE are mandatory,” the investigators wrote.

Using Taiwan's National Health Insurance Research Database (NHIRD) for the period 2000–2011, the investigators identified patients with newly diagnosed SLE and no history of ESRD. During a mean follow-up of 8.1 years, ESRD developed in 316 (4.3%) of the 7326 SLE patients. Male patients had a significant 56% higher risk for ESRD. Hypertension was associated with a significant 84% increased risk compared with the absence of hypertension.

Among the patients with different types of infectious complications, those with septicemia/bacteremia had the greatest risk for ESRD compared with patients who had no infection-related hospitalizations.

The rate of infection-related hospitalizations was 37.5% among patients with juvenile-onset SLE, 39% among those with late-onset SLE, and 27.7% among those with adult-onset SLE, the investigators reported. “The very young and very old SLE patients may be more predisposed to infections because hypocomplementemia and low concentrations of protective antibodies are more common in these groups,” they explained.

Major strengths of the study, the investigators noted, were the use of a nationwide population-based cohort of patients with newly diagnosed SLE from the NHIRD and a long mean follow-up period. The main limitations included the lack of detailed information on comorbidities, severity and extent of disease, certain laboratory data, and information on clinical course and treatment.

Reference

1. Lin C-H, Hung P-H, Hu H-Y, et al. Infection-related hospitalization and risk of end-stage renal disease in patients with systemic lupus erythematosus: a nationwide population-based study. Nephrol Dial Transplant 2016; published online ahead of print. 

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