Abstract: FR-PO416
Impact of Lupus on Mortality and Causes of Death in Patients on Dialysis: Okinawa Dialysis Study (OKIDS) Registry
Session Information
- Hemodialysis Epidemiology and Outcomes
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Oshiro, Nanako, Dialysis Unit, University of the Ryukyus Hospital, Nishihara-cho, Japan
- Kohagura, Kentaro, Dialysis Unit, University of the Ryukyus Hospital, Nishihara-cho, Japan
- Kusunose, Kenya, Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Rykyus, Nishihara-cho, Japan
- Iseki, Kunitoshi, Nakamura Clinic, Urasoe-city, Okinawa, Japan
Background
Lupus nephritis is one of the most serious complications of systemic lupus erythematosus (SLE), resulting in end-stage kidney disease (ESKD). Despite the introduction of immunosuppressive drugs in the 1990s, a certain number of patients with SLE still develop ESKD. It is known that after dialysis is initiated, SLE patients experience decreased disease activity and can discontinue steroids and immunosuppressive drugs at reduced doses (burn-out). However, it has been reported that hemodialysis patients with SLE have a lower life expectancy than non-SLE patients, although little is known about the causes of death. Our goal was to assess the relative risk of mortality and its causes associated with SLE among dialysis patients in Japan.
Methods
This retrospective longitudinal cohort study using the Okinawa Dialysis Study (OKIDS) registry included all chronic dialysis patients treated in Okinawa, Japan. Kaplan-Meier survival analyses were performed. The study included dialysis patients treated between 1 June 1971 and 31 December 2000, covering the entire OKIDS registry collection period. Patients were censored at death, renal transplantation, or when moving out of Okinawa. Cox proportional hazard models were used to assess whether SLE as a cause of ESKD was associated with an increased risk of death.
Results
A total of 5,246 patients (2,981 male and 2,265 female) were included in this study. There were 111 patients with ESKD secondary to SLE, 87 of whom were female. The patients with ESKD secondary to SLE had a more than 2-fold increased risk of death compared with other patients with ESKD (hazard ratio [HR]: 2.55, 95% confidence interval [CI]: 1.81-3.47, P< 0.0001), after adjusting for age, era at initiation of dialysis, and gender. When the cause of mortality was analyzed, the risk of cardiovascular death (HR: 1.94, 95% CI: 1.13-3.33, P=0.0158) and death due to infection (HR: 4.12, 95% CI: 2.40-7.37, P< 0.0001) were significantly high in SLE patients.
Conclusion
Our study has revealed the heightened mortality risk among dialysis patients secondary to SLE. While dialysis patients with SLE tend to be relatively young, we need to recognize that they constitute a high-risk group for mortality, emphasizing the importance of careful management of their treatment.