Persistent lupus activity in end-stage renal disease.

Area of Science:

• Nephrology
• Rheumatology
• Immunology

Background:

• Systemic lupus erythematosus (SLE) activity typically improves with end-stage renal disease (ESRD).
• However, many SLE patients with ESRD exhibit ongoing disease activity.
• This challenges the conventional understanding of lupus progression in renal failure.

Purpose of the Study:

• To investigate lupus activity in patients with SLE and ESRD undergoing dialysis or transplantation.
• To compare disease activity before and after developing ESRD.
• To identify factors influencing lupus activity in this patient cohort.

Main Methods:

• Retrospective study of 19 patients with SLE and ESRD (dialysis or transplant) between 1988-1994.
• Assessed clinical and serological markers of lupus activity, including specific symptoms and lab values.
• Utilized the SLE Disease Activity Index (SLEDAI) and immunosuppressive medication requirements for evaluation.

Main Results:

• Clinical lupus activity rates increased after ESRD, particularly in hemodialysis and peritoneal dialysis patients, though not always statistically significant.
• Serological markers showed minimal change in dialysis patients but tended to improve post-transplantation.
• A statistically significant increase in lupus activity was observed after both hemodialysis and peritoneal dialysis (P < 0.01).

Conclusions:

• Lupus activity can persist in patients with end-stage renal disease.
• Hemodialysis and peritoneal dialysis did not significantly reduce lupus activity and were associated with increased incidence.
• Renal transplantation showed a tendency towards improvement in lupus activity.
• The study population, predominantly black women, may represent a subgroup with persistent lupus activity despite ESRD.