【Abstract】Objective The purpose of this study was to evaluate the clinical efficacy of continuous ambulatory peritoneal dialysis (CAPD) for severe lupus nephritis (LN) patients complicated with important organ dysfunctions. Methods Eight patients diagnosed as severe LN complicated with multiple organ dysfunctions and undergoing CAPD from November 2003 to June 2008 were enrolled in this study. They were characterized by the following features: ①Methylprednisolone pulse therapy was required due to active lupus and progressive renal failure, but immunosuppressant could not be continuously applied due to high catabolism; ②Regular therapy failed due to severe edema, cardiac insufficiency and severe malnutrition; and ③Severe gastrointestinal symptoms. Catheterization surgery was carried out, and CAPD was conducted at 2,000ml/time and 3-4 times/day. Immunosuppressant was re-administered when the above features improved. Changes of renal function, nutrition status and systemic lupus erythematosus disease activity index (SLE-DAI), and the administration of immunosuppressant in these patients were followed up for at least 4 months. Results ①Clinical effects: Better general condition, regression of edema, and improvement of heart function, mental status and physical strength were found in the 8 patients. Renal function recovered significantly in all patients, and the CAPD discontinued in 5 of the 8 patients. ②Nutrition indices: Remarkable improvement was present in all patients. ③Immunological indices: In patients taking prednisone and other immunosuppressant therapy such as mycophenolate mofetil (MMF) after CAPD, ANA and anti-dsDNA antibody titers decreased significantly in 5 patients, and remained unchanged in 2 patients, and ANA titer increased in one patient. SLE-DAI decreased significantly after CAPD in all patients. ④Complications: Peritonitis occurred in one patient. Conclusion Peritoneal dialysis can be used in severe LN patients complicated with important organ dysfunctions. After peritoneal dialysis, edema, heart failure and azotemia improved, the residual renal function preserved, and the nutritional status ameliorated in these patients. When the patient’s condition improves, immunosuppressant should be resumed to treat the primary disease and to help recover the residual renal function.
ZHOU Yan
,
YU Yu-sheng
,
TANG Zheng
. Clinical analysis of peritoneal dialysis as an adjuvant therapy for severe lupus nephritis patients complicated with acute kidney injury[J]. Chinese Journal of Blood Purification, 2010
, 9(8)
: 418
-422
.
DOI: 10.3969/j.issn.1671-4091.2010.08.004
