Factors associated with refractory renal disease in patients with systemiclupus erythematosus: The role of patient nonadherence

Objective. To assess the prevalence and underlying reasons for the developm ent of chronic renal insufficiency (CRI) in patients with systemic lupus er ythematosus (SLE) seen over a 3-year period in our lupus clinic, in particu lar to determine the frequency and types of patient-dependent factors that were associated with nonadherence when it occurred. Methods. We determined the frequency and types of patient-dependent factors that were associated with the development of CRI in patients with SLE. CRI was defined as a serum creatinine level greater than or equal to 200 mu mo l/l for at least 6 months. Results. Of the 462 patients followed at the lupus clinic between 1995 and 1998, 17 patients developed CRI Patient-related factors were deemed to be t he major reason for the development of CRI in 5 of these. Three of the 5 pa tients were nonwhite, and the patients who were white were new immigrants. All 5 patients were reluctant to take high-dose corticosteroids because of potential adverse effects. Financial problems contributed to nonadherence i n 2 cases. Two patients refused to continue steroids and immunosuppressive therapy and chose to use "alternative" medications as their sole therapy. O f these 5 patients, 3 are now on long-term renal replacement therapy, I has died, and 1 patient continues to be followed with a serum creatinine level of 250 mu mol/l. Conclusion. There is a need for an educational program based on patients' c ultural background in order to enhance patients' understanding of the aims, risks, and benefits of therapy in SLE.