Le malattie immunitarie aumentano il rischio di complicanze infettive?
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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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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


Le malattie immunitarie aumentano il rischio di complicanze infettive gianfranca cabiddu

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


Le malattie immunitarie aumentano il rischio di complicanze infettive gianfranca cabiddu

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


Le malattie immunitarie aumentano il rischio di complicanze infettive gianfranca cabiddu

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


Le malattie immunitarie aumentano il rischio di complicanze infettive gianfranca cabiddu

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


Le malattie immunitarie aumentano il rischio di complicanze infettive gianfranca cabiddu

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.


Le malattie immunitarie aumentano il rischio di complicanze infettive gianfranca cabiddu

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).


Le malattie immunitarie aumentano il rischio di complicanze infettive gianfranca cabiddu

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.


Le malattie immunitarie aumentano il rischio di complicanze infettive gianfranca cabiddu

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


Le malattie immunitarie aumentano il rischio di complicanze infettive gianfranca cabiddu

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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