Objectives We evaluated the association of lupus nephritis (LN) and adverse pregnancy outcomes in prospective cohorts of pregnant women with SLE (systemic lupus erythematosus). Methods We conducted a patient-level pooled analysis of data from three cohorts of pregnant women with SLE. Pooled logistic regression models were used to evaluate the association of LN and adverse pregnancy outcomes. Odds ratios and 95% confidence intervals were calculated using a fixed effect model by enrolling cohort. Results The pooled cohort included 393 women who received care at clinics in the United States and Canada from 1995 to 2015. There were 144 (37%) women with a history of LN. Compared to women without LN, those with LN had higher odds of fetal loss (OR: 1.90; 95% CI: 1.01, 3.56) and preeclampsia (OR: 2.04; 95% CI: 1.01, 4.13). Among the 31 women with active nephritis (defined as urine protein ≥ 0.5 g/24 h) there was a higher odds of poor pregnancy outcome (OR: 3.08; 95% CI: 1.31, 7.23) and fetal loss (OR: 6.29; 95% CI: 2.52, 15.70) compared to women without LN. Conclusions In this pooled cohort of women with SLE, a history of LN was associated with fetal loss and preeclampsia. Active nephritis was associated with poor pregnancy outcome and fetal loss.

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Background: Potentially inappropriate medications, or medications that generally carry more risk of harm than benefit in older adults, are commonly prescribed to older adults receiving dialysis. Deprescribing, a systematic approach to reducing or stopping a medication, is a potential solution to limit potentially inappropriate medications use. Our objective was to identify clinicians and patient perspectives on factors related to deprescribing to inform design of a deprescribing program for dialysis clinics. Methods: We conducted rapid qualitative analysis of semi-structured interviews and focus groups with clinicians (dialysis clinicians, primary care providers (PCPs), and pharmacists) and patients (adults receiving hemodialysis aged ≥65 years and those aged 55-64 years who were pre-frail or frail ) from March 2019 to December 2020. Results: We interviewed 76 participants [53 clinicians (8 focus groups and 11 interviews) and 23 patients]. Among clinicians, 24 worked in dialysis clinics, 18 worked in primary care, and 11 were pharmacists. Among patients, 13 (56%) were aged ≥65 years, 14 (61%) were Black race, and 16 (70%) reported taking at least one potentially inappropriate medication. We identified four themes (and corresponding subthemes) of contextual factors related to deprescribing potentially inappropriate medications: 1) system-level barriers to deprescribing (limited electronic medical record interoperability, time constraints and competing priorities), 2) undefined co-management among clinicians (unclear role delineation, clinician caution about prescriber boundaries), 3) limited knowledge about potentially inappropriate medications (knowledge limitations among clinicians and patients), and 4) patients prioritize symptom control over potential harm (clinicians expect resistance to deprescribing, patient weigh risks and benefits). Conclusions: Challenges to integration of deprescribing into dialysis clinics included siloed health systems, time constraints, co-management behaviors, and clinician and patient knowledge and attitudes towards deprescribing.