Le malattie immunitarie aumentano il rischio di complicanze infettive?

Gianfranca Cabiddu

Divisione Nefrologia Azienda Ospedaliera Brotzu- Cagliari

Clinical outcomes of systemic lupus erythematosus patients undergoing continous ambulatory peritoneal dialysis Siu YPNephrol Dial Transplant (2005); 20: 2797-2802

SYSTEMIC LUPUS ERYTHEMATOSUS AND PERITONEAL DIALYSIS: OUTCOMES AND INFECTIOUS COMPLICATIONS

Huang JW

Perit Dial Int 2001; 21: 143-147

Infectious complications and outcome in lupus patients with ESRF treated with CAPD

Huang Huang et alet al.(2001).(2001) Siu Siu et alet al.. (2005)(2005)

SLE Controls SLE Controls

Males/females (n) 3/20 6/40 5/13 10/26Age (years) 33.9 ± 7.6 34.3 ± 7.4 40.8±10.3 42.2±7.3Duration 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±5.6Immunosuppression 56.5 ? 88.8 5.5 at start of PD (%) Peritonitis 0.38 0.18 0.68 0.28Exit-site infections 0.24 0.12 0.24 0.20Other infections ? ? 0.80 0.13

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 2Huang- Perit Dial Int 2001; 21: 143-147

Total number of episodes and type of infective complications

Types of infective complications Total n° of episodes P-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) 0.37

epididymo-orchitis, vaginitis

Skeletal (tuberculosis of spine) 0 (0) 1 (0.03±0.03) 0.32

Sui YP Nephrol Dial Transplant (2005) 20: 2797–2802

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.

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 immunosuppressed patients was 1,8 episodes/patient-year and in those without immunosuppression 0,68 (P<0,01).

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 risk factor for CAPD peritonitis.

CAPD may not be the initial therapy of choice in this high-risk group.

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 10/26Age (years) 33.9±7.6 34.3±7.4 40.8±10.3 42.2±7.3Duration of PD 44.9 ± 24.0 47.3 ± 35.3 35.4±20.7 36.7±28.2(months)

Immunosuppression 56.5 ? 88.8 5.5 at start of PD (%) Peritonitis 0.38+ 0.18 0.68§ 0.28Exit-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

Albumin (g/dl) 31.6 ± 5.0∗ 35.2 ± 5.0 30.4±6.6∗ 35.4±5.6

Nephrol Dial Transplant (2008) 23: 3056–3060 Editorial Review

Renal replacement therapy in lupus nephritis Anke Rietveld and Jo H. M. BerdenTreatment of lupus patients with haemodialysis has comparable

results as in non lupus patients.

Therefore, haemodialysis is preferred over CAPD, especially if the patient is still using immunosuppressives.

In contrast, during CAPD treatment, peritonitis and other infectious complications are more frequent in lupus patients.