Poor prognosis in end-stage lupus nephritis due to nonautologous vascular access site associated septicemia and lupus flares

Am J Nephrol. 1989;9(4):279-84. doi: 10.1159/000167981.


A poor prognosis was observed in patients who had end-stage renal disease (ESRD) as a result of systemic lupus erythematosus (SLE). This was true even in patients in whom SLE disease activity was transiently quiescent during the period of hemodialysis. Six of 9 patients with ESRD and SLE died with active SLE and/or sepsis 1-28 months following the onset of dialysis. In 5 of the 6 patients, acute inflammatory activity of SLE flared within 1 month of the patient's death. Four patients died with superimposed sepsis, but only 2 of the 4 were receiving high-dose concomitant immunosuppressives for more than 1 week prior to death. Infected hemodialysis vascular access sites were implicated as the source of septicemia in 3 of 4 infectious deaths. The 3 surviving patients had minimal lupus activity prior to the development of ESRD, a possible marker for stability in SLE patients who require hemodialysis. Our results suggest that hemodialyzed lupus patients with nonautologous vascular access sites may be at continued increased risk for life-threatening inflammatory and septic complications.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Bacterial Infections / complications*
  • Bacterial Infections / drug therapy
  • Cyclophosphamide / therapeutic use
  • Female
  • Humans
  • Kidney Failure, Chronic / etiology*
  • Lupus Erythematosus, Systemic / complications*
  • Lupus Erythematosus, Systemic / drug therapy
  • Lupus Nephritis / etiology*
  • Male
  • Middle Aged
  • Prednisone / therapeutic use
  • Prognosis
  • Renal Dialysis
  • Sepsis / complications*
  • Sepsis / drug therapy
  • Time Factors


  • Cyclophosphamide
  • Prednisone