Divergent Practice Patterns in Lupus Nephritis Care: A National Survey of Rheumatologists and Nephrologists in Saudi...

This study aimed to investigate specialty-driven similarities and differences in the management of patients with lupus nephritis in Saudi Arabia.

A cross-sectional, self-reported, electronic survey was distributed to adult rheumatologists and nephrologists practicing in Saudi Arabia, achieving a response rate of 31% (158 of 500 clinicians contacted through national specialty-society distribution lists). The questionnaire assessed demographic characteristics, institutional settings, and lupus nephritis management practices. Associations between specialty and survey responses were analysed using Pearson's χ 2 or Fisher's exact tests, with statistical significance defined as a two-sided p-value <0.05.

A total of 158 clinicians participated, with equal representation of rheumatologists and nephrologists (79 each). Nephrologists were more frequently male (81.0% vs. 60.8%; χ 2 p=0.005), whereas rheumatologists were younger and had fewer years of clinical experience (p=0.005). Marked specialty-based differences were observed in induction strategies. Rheumatologists more frequently administered higher-dose pulse methylprednisolone (1000 mg vs. 500 mg; p=0.015) and were more likely to prescribe mycophenolate mofetil (MMF) for class III/IV ± V lupus nephritis (88.6% vs. 73.4%). In contrast, nephrologists demonstrated greater reliance on cyclophosphamide-based regimens (26.6% vs. 11.4%; p=0.015). Significant variation was also evident in supportive care practices. Nephrologists more commonly prescribed Pneumocystis jirovecii pneumonia (PJP) prophylaxis (22.8% vs. 5.1%; p=0.005), while rheumatologists more frequently implemented gonadal protection during cyclophosphamide therapy (94.6% vs. 74.0%; p=0.003).

Variation in lupus nephritis management was observed between rheumatologists and nephrologists in Saudi Arabia, highlighting potential care gaps and areas for standardization. A multidisciplinary approach can lead to a more comprehensive, unified care. Future studies are recommended to evaluate quality indicators in the management of lupus nephritis.