Systemic Lupus Erythematosus in Patients with End-Stage Renal Disease: Long-Term Follow-Up on the Prognosis of Patients and the Evolution of Lupus Activity

Cheigh, Jhoong S.; Kim, Hong; Stenzel, Kurt H.; Tapia, Luis; Sullivan, John; Stubenbord, William T.; Riggio, Robert R.; Rubin, Albert L.

doi:10.1016/s0272-6386(12)81017-1

Cited by 83 publications

(63 citation statements)

References 24 publications

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“…This so-called "burn-out" phenomenon was first described by Fries et al (6) However, SLE flare during dialysis is also not rare. Some investigators reported that several risk factors could predict the persistence of activity of SLE (4,5,7). In the present report, we describe the results of a retrospective study performed to evaluate clinically and serologically the activity of SLEin patients with ESRDon maintenance hemodialysis therapy.…”

Section: Introductionmentioning

confidence: 84%

“…In 1984, Pahl et al (7) reported that the disease activity of SLE persisted in six of 1 1 patients after the initiation of dialysis. Several investigators also reported that the disease activity persisted in some SLE patients at least during the first year of dialysis (3,4,7,8). However, many clinicians believe that SLE becomesless active or burns out after the development of ESRD.…”

Section: Discussionmentioning

confidence: 99%

“…About 20%of patients progressing to ESRDrequire maintenance dialysis or renal transplantation within ten years (2,5). The activity of SLE after the development of ESRDhas been reported by several groups (3)(4)(5)(6)(7)(8)(9). According to many reports, the activity of SLEafter the development of ESRDtends to decline as reflected by the clinical and serological features.…”

Section: Introductionmentioning

confidence: 94%

“…Lupus nephritis occurs in 50% to 80% of SLE patients (1) and has a strong impact on the prognosis; the high morbidity and mortality of patients with SLE are associated with the severity of lupus nephritis (2)(3)(4). About 20%of patients progressing to ESRDrequire maintenance dialysis or renal transplantation within ten years (2,5).…”

Section: Introductionmentioning

confidence: 99%

“…According to many reports, the activity of SLEafter the development of ESRDtends to decline as reflected by the clinical and serological features. Cheigh et al (4) reported that lupus activity was clinically apparent in 55.4% of patients with ESRDduring the first year and in 6.5% during the fifth year. It was believed that the disease became inactive within ten years of the development of ESRD.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of Lupus Activity in End-Stage Renal Disease Treated by Hemodialysis.

et al. 2001

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Objective The activity of systemic lupus erythematosus (SLE) has been reported to decrease in patients who have developed end-stage renal disease (ESRD). However, extrarenal symptomsattributable to the disease activity are noted, especially during the first year of dialysis. Westudied the clinical course and evaluate the disease activity of SLEin patients with ESRDon hemodialysis for more than 6 months. Subject and Methods Fourteen patients with SLEwho had been initiated on maintenance dialysis at our center between 1982 and 1999 were examined retrospectively.Their clinical details, organ system manifestations, serologic profiles and immunosuppressive treatment regimens were reviewed. Patients with and without postdialysis flaras of SLEwere compared statistically. Results Five patients exhibited 6 SLE flares under treatment with corticosteroids. Twoflares occurred within the first year of the initiation of dialysis, and in 1 patient, aggravation of the disease activity was noted 98 months after the initiation of dialysis. Polyarthritis was noted in 5 cases and fever in 4 cases. The serum complement levels decreased in all 6 cases with relapse of SLEactivity. Comparedwith the other 9 patients who did not exhibit SLE relapse, no significant differences were found in 5 patients who did with respect to the demographic and serologic features at the initiation of dialysis.Conclusion Weconclude that the disease activity does not always burn out in patients of SLEwhoshow progression to ESRD. SLEflares can sometimesoccur even after one year of the initiation of dialysis. SLEpatients on dialysis should be carefully followed up by clinical and serological monitoring, and treated by appropriate immunosuppressive therapy. (Internal Medicine 40: 598-602, 2001)

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Section: Introductionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Analysis of Lupus Activity in End-Stage Renal Disease Treated by Hemodialysis.

et al. 2001

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Frequency of recurrent lupus nephritis among ninety-seven renal transplant patients during the cyclosporine era

Stone

Millward

Olson

et al. 1998

Arthritis & Rheumatism

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Prescribing Patterns of Hydroxychloroquine and Glucocorticoids Among Lupus Patients After New‐Onset End‐Stage Renal Disease

Broder

Mowrey

Valle

et al. 2022

Arthritis Care & Research

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Objective. Optimal strategies for managing lupus medications after end-stage renal disease (ESRD) have not been addressed. The objective was to identify the current US-wide prescribing patterns of hydroxychloroquine (HCQ) and oral glucocorticoids (GS) among systemic lupus erythematosus (SLE) patients with incident ESRD enrolled in the US Renal Data System (USRDS) registry.Methods. We identified incident ESRD patients age ≥18 years with SLE as a primary cause of ESRD between January 2006 and June 2013. Patients who were started on dialysis at ESRD onset and enrolled in Medicare Part D within 93 days as required by Medicare were included.Results. Among the 2,654 new-onset ESRD patients with Part D, the median duration of follow-up was 761 days (interquartile range [IQR] 374-1,375). At baseline, 1,076 patients (41%) were not receiving HCQ or GS, 220 (8%) were prescribed HCQ alone, 509 (19%) were prescribed both HCQ and GS, and 849 (32%) were prescribed GS alone. Of the 1,983 patients who either never received or discontinued HCQ after ESRD onset, 667 (34%) continued GS to the end of the follow-up period. The median GS dose was lower for patients taking HCQ (14 mg [IQR 9-21]) compared to patients who were never prescribed HCQ (15 mg ) or patients who discontinued HCQ after ; P = 0.001).Conclusion. Approximately one-third of patients with lupus nephritis and new-onset ESRD received GS monotherapy at high doses. As GS-related complications contribute to hospitalizations and deaths in SLE ESRD, changing these prescribing practices may improve morbidity and mortality outcomes.

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Systemic Lupus Erythematosus in Patients with End-Stage Renal Disease: Long-Term Follow-Up on the Prognosis of Patients and the Evolution of Lupus Activity

Cited by 83 publications

References 24 publications

Analysis of Lupus Activity in End-Stage Renal Disease Treated by Hemodialysis.

Analysis of Lupus Activity in End-Stage Renal Disease Treated by Hemodialysis.

Frequency of recurrent lupus nephritis among ninety-seven renal transplant patients during the cyclosporine era

Prescribing Patterns of Hydroxychloroquine and Glucocorticoids Among Lupus Patients After New‐Onset End‐Stage Renal Disease

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