Watch for early cardiac disease in pediatric patients with renal disease caused by SLE

Pediatric patients with renal disease secondary to systemic lupus erythematosus (SLE) have nearly twice the risk of death compared with pediatric patients with renal disease secondary to other causes.

Most of the excess deaths in patients with renal disease secondary to SLE are caused by cardiovascular disease, according to a study published in Pediatric Nephrology.

As such, careful monitoring and aggressive treatment of traditional cardiovascular disease risk factors and attention to nontraditional risk factors is warranted in patients who begin hemodialysis at age 18 or earlier, recommend investigators.

They examined the United States Renal Data System, a database that tracks death and kidney transplantation in all patients in the United States with end-stage renal disease. Some 98,483 children and adults maintained on hemodialysis between January 1, 1990, and December 31,1994, were identified from the database; 1,513 had SLE, 171 of whom were children.

Pediatric patients with SLE had 2.4 times the rate of death compared with pediatric patients with other forms of renal disease. Cardiovascular disease and cardiac arrest accounted for 75% of the deaths in pediatric patients with SLE secondary to renal disease, making it 3 times more common as a cause of death compared with pediatric patients with non-lupus renal disease.

Patients with SLE are more likely to develop hypertension and dyslipidemia at an early age, researchers noted, and much like other autoimmune diseases SLE promotes an inflammatory state that may lead to premature atherosclerosis and cardiovascular events.

Guidelines for cardiovascular risk assessment and treatment for patients with SLE have been developed. The recommendations include maintaining a body mass index less than 25 kg/m², achieving a level of low-density lipoprotein cholesterol less than 100 mg/dL, checking blood pressure at every visit (and between visits in patients taking corticosteroids), and monitoring fasting glucose yearly.

The investigators also suggest incorporating assessment of nontraditional risk factors that indicate an inflammatory state.

Sule S, Fivush B, Neu A, Furth S. Increased risk of death in pediatric and adult patients with ESRD secondary to lupus. Pediatr Nephrol. 2011;26(1):93-98.