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Le malattie immunitarie aumentano il rischio di complicanze infettive? Gianfranca Cabiddu

Le malattie immunitarie aumentano il rischio di complicanze infettive? Gianfranca Cabiddu Divisione Nefrologia Azienda Ospedaliera Brotzu- Cagliari. SYSTEMIC LUPUS ERYTHEMATOSUS AND PERITONEAL DIALYSIS: OUTCOMES AND INFECTIOUS COMPLICATIONS Huang JW

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Le malattie immunitarie aumentano il rischio di complicanze infettive? Gianfranca Cabiddu

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  1. Le malattie immunitarie aumentano il rischio di complicanze infettive? Gianfranca Cabiddu Divisione Nefrologia Azienda Ospedaliera Brotzu- Cagliari

  2. SYSTEMIC LUPUS ERYTHEMATOSUS AND PERITONEAL DIALYSIS: OUTCOMES AND INFECTIOUS COMPLICATIONS Huang JW Perit Dial Int 2001; 21: 143-147 Clinical outcomes of systemic lupus erythematosus patients undergoing continous ambulatory peritoneal dialysis Siu YP Nephrol Dial Transplant (2005); 20: 2797-2802

  3. Infectious complications and outcome in lupus patients with ESRF treated with CAPD Huang et al.(2001)Siu et al. (2005) SLE Controls SLE Controls Males/females (n) 3/20 6/40 5/13 10/26 Age (years) 33.9 ± 7.6 34.3 ± 7.4 40.8±10.3 42.2±7.3 Duration of PD 44.9±24.0 47.3±35.3 35.4±20.7 36.7±28.2 (months) Albumin (g/dl) 31.6 ± 5.035.2 ± 5.0 30.4±6.635.4±5.6 Immunosuppression 56.5 ? 88.8 5.5 at start of PD (%) Peritonitis 0.380.18 0.680.28 Exit-site infections 0.240.12 0.24 0.20 Other infections ? ? 0.800.13

  4. Outcomes of Peritoneal Dialysis Patients with Systemic Lupus Erythematosus (SLE) Versus Gender- and Age-Matched Control Group SLE Control Outcome (n =23) (n =46) Remain on PD 5 (22%) 25 (54%) Dropped out, due to: Peritonitis 8 (35%) 4 (9%) Transplant 1 (4%) 9 (20%) Death 8 (35%) 5 (11%) Sepsis 5 2 Lupus encephalitis 1 0 Intracerebral hemorrhage 1 1 Cardiovascular event 1 2 Huang- Perit Dial Int 2001; 21: 143-147

  5. Total number of episodes and type of infective complications Types of infective complicationsTotal n° of episodesP-value (mean episodes per 100 patient-months) SLE group CGn group Peritonitis 40 (5.7±1.64) 37 (2.37±0.58) 0.02 Dialysis catheter exit site infection 16 (1.88±0.87) 14 (1.69±0.68) 0.87 Respiratory (pneumonia) 23 (3.25±1.08) 4 (0.38±0.21) 0.001 Cutaneous (cellulitis, subcutaneous abscess) 3 (1.08±0.68) 3 (0.15±0.09) 0.06 Gastrointestinal (gastroenteritis) 5 (1.59±0.89) 4 (0.26±0.15) 0.047 Cardiovascular (pericarditis, endocarditis) 4 (0.54±0.31) 0 (0) 0.014 Genitourinary (urinary tract infection, 1 (0.09±0.09) 4 (0.28±0.14) 0.37epididymo-orchitis, vaginitis Skeletal (tuberculosis of spine) 0 (0) 1 (0.03±0.03) 0.32 Sui YP Nephrol Dial Transplant (2005) 20: 2797–2802

  6. SYSTEMIC LUPUS ERYTHEMATOSUS AND PERITONEAL DIALYSIS: OUTCOMES AND INFECTIOUS COMPLICATIONS Huang JW Perit Dial Int (2001) SLE patients who tapered off steroid therapy after commencing PD had a lower incidence of peritonitis than the other patients remaining on steroid therapy.

  7. Original Article Impaired outcome of continuous ambulatory peritoneal dialysis in immunosuppressed patients P. A. Andrews, K. J. Warr, J. A. Hicks and J. S. Cameron Nephrol Dial Transplant (1996); 11: 1104-1108 The peritonitis frequency in the immunosuppressedpatients was 1,8 episodes/patient-year and in those without immunosuppression 0,68 (P<0,01).

  8. Original Article Impaired outcome of continuous ambulatory peritoneal dialysis in immunosuppressed patients P. A. Andrews, K. J. Warr, J. A. Hicks and J. S. Cameron Nephrol Dial Transplant (1996); 11: 1104-1108 Immunosuppression is an important riskfactor for CAPD peritonitis. CAPD may not be the initial therapy of choice inthis high-risk group.

  9. Infectious complications and outcome in lupus patients with ESRF treated with CAPD Huang et al. Siu et al. SLE Controls SLE Controls Males/females (n) 3/20 6/40 5/13 10/26 Age (years) 33.9±7.6 34.3±7.4 40.8±10.3 42.2±7.3 Duration of PD 44.9 ± 24.0 47.3 ± 35.3 35.4±20.7 36.7±28.2 (months) Albumin (g/dl) 31.6 ± 5.0∗35.2 ± 5.0 30.4±6.6∗35.4±5.6 Immunosuppression 56.5 ? 88.8 5.5 at start of PD (%) Peritonitis 0.38+0.18 0.68§0.28 Exit-site infections 0.24∗0.12 0.24 0.20 Other infections ? ? 0.80∗0.13 ∗ P<0,01 + P<0,0001 § P<0,02

  10. Nephrol Dial Transplant (2008) 23: 3056–3060 Editorial Review Renal replacement therapy in lupus nephritis Anke Rietveld and Jo H. M. Berden • Treatment of lupus patients with haemodialysis has comparable results as in non lupus patients. • In contrast, during CAPD treatment,peritonitis and other infectious complications are more frequent in lupus patients. • Therefore, haemodialysis is preferred over CAPD, especially if the patient is still using immunosuppressives.

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