Factors associated with active systemic lupus erythematosus after endstage renal disease

Activity of systemic lupus erythematosus (SLE) often declines after patients reach endstage renal disease (ESRD). However, extrarenal activity is not uncommon, especially during the first few years of dialysis. We reviewed the clinical course of SLE patients with ESRD treated in our unit over the past 10 years, and tried to identify factors associated with postdialysis activity.

A retrospective study of 18 patients with SLE (6 males) who received maintenance dialysis in our center from 1987 to 1996. Their clinical details, organ system manifestations, serologic profile, and treatment were reviewed. Patients with and without lupus flares after maintenance dialysis were compared.

Duration of followup was 43.4 +/- 32.7 months before dialysis and 33.8 +/- 28.9 months afterwards (4 hemodialysis, 14 peritoneal dialysis). Nine patients experienced 32 lupus postdialysis flares. The frequency was 0.63 flare per patient-year. Twenty flares (62.5%) developed within the first year of dialysis. Compared with the other 9 patients who had no flares, patients with flares were younger (median age at diagnosis of SLE 24 vs 33 years; median age when dialysis was initiated 26 vs 37 years; p < 0.05 both, Mann-Whitney U test) and more likely to have history of seizure (6 in 9 vs 1 in 9 patients, p < 0.05, Fisher's exact test). There was a trend that patients with history of serositis and vasculitis were also associated with postdialysis activity, although this was not statistically significant.

Postdialysis flare of SLE is not uncommon, particularly during first year of dialysis. Younger patients and those with history of seizure may have higher risk of postdialysis lupus flare. Careful followup is warranted, especially in potential transplant recipients.