Improving Outcomes in Patients with Lupus and End-Stage Renal Disease

Authors

  • Antonio Inda-Filho,

    1. Division of Nephrology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
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  • Joel Neugarten,

    1. Division of Nephrology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
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  • Chaim Putterman,

    1. Division of Rheumatology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
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  • Anna Broder

    Corresponding author
    1. Division of Rheumatology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
    • Division of Nephrology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
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Address correspondence to: Anna Broder, MD, MSc., Division of Rheumatology, Albert Einstein College of Medicine F103N, 1300 Morris Park Ave, Bronx, NY 10461, Tel.: (718) 430-8582, Fax: (718) 430-8789, or E-mail: abroder@montefiore.org.

Abstract

The development of lupus-related end-stage renal disease (ESRD) confers the highest mortality rates among individuals with lupus. Lupus-related ESRD is also associated with higher morbidity and mortality rates compared with non-lupus ESRD. We review the evidence that persistent lupus activity, hypercoagulability, and continuing immunosuppression may contribute to unfavorable outcomes in dialysis and renal transplantation among lupus patients. Robust epidemiologic studies are needed to develop individualized evidence-based approaches to treating lupus-related ESRD. In the meantime, managing lupus-related ESRD presents a significant challenge for clinicians and requires a team approach involving nephrologists and rheumatologists. Goals of therapy after developing ESRD should include continuing monitoring of lupus activity, minimizing corticosteroid exposure, and choosing the most appropriate renal replacement therapy based on patient's risk profile and quality-of-life considerations.

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