Analysis of lupus activity in end-stage renal disease treated by hemodialysis

Objective The activity of systemic lupus erythematosus (SLE) has been repor ted to decrease in patients who have developed end-stage renal disease (ESR D). However, extrarenal symptoms attributable to the disease activity are n oted, especially during the first year of dialysis. We studied the clinical course and evaluate the disease activity of SLE in patients with ESRD on h emodialysis for more than 6 months. Subject and Methods Fourteen patients with SLE who had been initiated on ma intenance dialysis at our center between 1982 and 1999 were examined retros pectively. Their clinical details, organ system manifestations, serologic p rofiles and immunosuppressive treatment regimens were reviewed. Patients wi th and without postdialysis flaras of SLE were compared statistically. Results Five patients exhibited 6 SLE flares under treatment with corticost eroids. Two flares occurred within the first year of the initiation of dial ysis, and in I patient, aggravation of the disease activity was noted 98 mo nths after the initiation of dialysis. Polyarthritis was noted in 5 cases a nd fever in 4 cases. The serum complement levels decreased in all 6 cases w ith relapse of SLE activity. Compared with the other 9 patients who did not exhibit SLE relapse, no significant differences were found in 5 patients w ho did with respect to the demographic and serologic features at the initia tion of dialysis. Conclusion We conclude that the disease activity does not always burn out i n patients of SLE who show progression to ESRD. SLE flares can sometimes oc cur even after one year of the initiation of dialysis. SLE patients on dial ysis should be carefully followed up by clinical and serological monitoring , and treated by appropriate immunosuppressive therapy.