Background/Purpose: SLE disease activity tends to diminish after the development of end stage renal disease (ESRD)^{1, 2}. Nonetheless, some patients continue to show signs of active disease and experience flares after ESRD³. To date, little is known about the evolution of SLE-related symptoms pre and post ESRD. Whether specific symptoms abate after ESRD or a shift towards different manifestations occurs deserves further study. Prompt identification of subtler SLE manifestations is further complicated by a trend towards poor rheumatology follow once ESRD develops. SLE manifestations post-ESRD may be underdiagnosed and undertreated contributing to increased morbidity and mortality. Therefore, the objective of this study was to analyzed the different clinical manifestations and serological markers of SLE disease activity before and after ESRD development.   

Methods: We performed a retrospective chart review of SLE patients with ESRD at a tertiary care center between the years of 2010 and 2017. SLE was defined by ACR and/or SLICC criteria. SLE ESRD patients were included if they had at least one visit with rheumatology, nephrology, or primary care pre- and post-ESRD. SLE-related symptoms and serologic markers of disease activity were identified from chart review before and after ESRD onset.

Results:

Fifty-eight patients were included. Twenty-five patients had a least one clinical non-renal criteria documented pre-ESRD. Of them, 14 achieved complete clinical remission post-ESRD.  Post-ESRD, cytopenias persisted in 49 of the 55 patients who were cytopenic pre-ESRD. Arthritis persisted in 3 of the 13 patients who had arthritis pre-ESRD. Of the 37 patients with hypocomplementemia pre-ESRD, 29 remained hypocomplementemic post-ESRD. Twenty-nine had elevated dsDNA pre-ESRD, of them, dsDNA remained elevated in 16 patients post-ESRD. Six patients developed at least one new clinical criteria post-ESRD. Three patients developed low complement and 5 developed elevated dsDNA post-ESRD.

Conclusion: Lupus activity may diminish after ESRD onset. However, many patients experience persistent disease activity. New arthritis, low complements and elevated dsDNA may develop after ESRD. Limited evaluation and documentation of disease activity by non-rheumatology providers may have resulted in under-reporting of SLE signs and symptoms on this study. SLE ESRD patients should be carefully evaluated for subtle signs of active SLE.

« Back to 2019 ACR/ARP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-and-serological-lupus-activity-before-and-after-developing-end-stage-renal-disease/