FACTORS ASSOCIATED WITH ACTIVE SYSTEMIC LUPUS-ERYTHEMATOSUS AFTER END-STAGE RENAL-DISEASE

Objective, Activity of systemic lupus erythematosus (SLE) often declin es after patients reach endstage renal disease (ESRD). However, extrar enal activity is not uncommon, especially during the first few years o f dialysis. We reviewed the clinical course of SLE patients with ESRD treated in our unit over the past 10 years, and tried to identify fact ors associated with postdialysis activity. Method. A retrospective stu dy of Is 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. Patie nts with and without lupus flares after maintenance dialysis were comp ared.Results. Duration of followup was 43.4 +/- 32.7 months before dia lysis and 33.8 +/- 28.9 months afterwards (4 hemodialysis, 14 peritone al dialysis). Nine patients experienced 32 lupus postdialysis flares. The frequency was 0.63 flare per patient-year. Twenty flares (62.5%) d eveloped 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 i nitiated 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 o f serositis and vasculitis were also associated with postdialysis acti vity, although this was not statistically significant. Conclusion. Pos tdialysis flare of SLE is not uncommon, particularly during first year of dialysis, Younger patients and those with history of seizure may h ave higher risk of postdialysis lupus flare. Careful followup is warra nted, especially in potential transplant recipients.