Disease flare not uncommon in SLE patients on dialysis

Nearly one in four patients with systemic lupus erythematosus (SLE) suffer a disease flare during dialysis, with most having haematological manifestations such as thrombocytopaenia, a study has shown.

A team of investigators reviewed the medical records of SLE patients who received dialysis at two tertiary hospitals in South Korea. They analysed disease activity in terms of the nonrenal SLE Disease Activity Index (SLEDAI) and evaluated the factors associated with SLE flares.

A total of 121 patients with SLE underwent dialysis, of whom 96 (79.3 percent) were on haemodialysis (HD) and 25 (20.7 percent) on peritoneal dialysis (PD). Thirty-two (26.4 percent) patients had an SLE flare (HD: n=25; PD: n=7) during a median follow-up of 45 months.

The most common features of SLE flare were constitutional (40.6 percent) and haematologic manifestations (40.6 percent), specifically thrombocytopaenia (31.2 percent) and leukopaenia (21.8 percent). Among constitutional symptoms, fever was the most common (34.3 percent).

Treatment for SLE flares were based on corticosteroids. Eleven (34.3 percent) patients were given additional immunosuppressants, including cyclophosphamide and mycophenolate mofetil.

Of note, nonrenal SLEDAI score prior to dialysis initiation (hazard ratio, 1.24, 95 percent confidence interval, 1.12‒1.36; p=0.001) was significantly associated with an increased risk of disease flare during dialysis.

“Continued follow-up and appropriate treatments, including immunosuppressants, should be considered for patients with SLE receiving dialysis,” the investigators said.