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Kidney Int:狼疮性肾炎患者终末期肾病的远期结局

2021-09-24 从医路漫漫 MedSci原创

狼疮性肾炎继发终末期肾病(ESKD)的患者预后尚未得到很好的描述。

目的:狼疮性肾炎继发终末期肾病(ESKD)的患者预后尚未得到很好的描述。为了帮助确定这一点,我们将狼疮性肾炎引起的ESKD患者的透析和移植结果与所有其他原因进行了比较。

方法:所有在澳大利亚和新西兰开始肾脏替代治疗(1963-2012年)的被诊断为ESKD的患者都包括在内。临床结果在当代队列(1998-2012年)和整个50年队列中进行了评估。

结果:在纳入的64,160名患者中,有744名患者以狼疮性肾炎为主要肾脏疾病。在425名狼疮性肾炎患者的同期队列中,透析患者的5年存活率为69%。在176例首次接受同种异体肾移植的狼疮性肾炎患者中,5年患者、全部同种异体肾移植患者和死亡审查同种异体肾移植患者的生存率分别为95%、88%和93%。与ESKD对照组相比,狼疮性肾炎患者透析存活率(调整风险比1.33,95%可信区间1.12-1.58)和肾移植存活率(调整风险比1.87,95%可信区间1.18-2.98)较差,但总体肾移植存活率(调整风险比1.19,95%可信区间0.84-1.68)和死亡审查肾移植存活率(调整风险比1.05,95%可信区间0.68-1.62)与ESKD对照组相比差异无统计学意义。在使用竞争风险分析时,在整个队列中也发现了类似的结果。

图1 1998年至2012年间,澳大利亚和新西兰透析患者狼疮性肾炎ESKD和其他ESKD原因的生存曲线。(a)Kaplan–Meier生存曲线。调整后的生存曲线。两组之间的差异有统计学意义(校正P= 0.001)。

图2 1998年至2012年在澳大利亚和新西兰接受透析的患者中,狼疮性肾炎ESKD和其他ESKD原因的累积危险肾功能恢复存活曲线。(a)Kaplan–Meier生存曲线。调整后的生存曲线。两组之间的差异无统计学意义(校正p=0.32)。

图3 1998年至2012年,在澳大利亚和新西兰进行肾移植的狼疮肾炎、ESKD和其他原因导致的同种异体肾移植患者的第一次移植存活曲线。(a) Kaplan-Meier生存曲线。(b)调整生存曲线。两组间差异无统计学意义(校正p=0.83)。

图4 1998 - 2012年澳大利亚和新西兰肾移植患者狼疮肾炎、ESKD和其他原因导致ESKD的移植患者生存曲线(a) Kaplan-Meier生存曲线。(b)调整生存曲线。两组间差异有统计学意义(校正p=0.008)。

结论:因此,狼疮性肾炎的ESKD与透析和移植患者的存活率较差有关,但与其他原因的ESKD相比,同种异体肾移植存活率相当。

原文出处:

Zhang L,  Lee G,  Liu X,et al,Long-term outcomes of end-stage kidney disease for patients with lupus nephritis.Kidney Int 2016 06;89(6)

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    2021-09-26 villahu
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    2021-09-26 gwc389

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