SYSTEMIC LUPUS-ERYTHEMATOSUS IN PATIENTS WITH END-STAGE RENAL-DISEASE - LONG-TERM FOLLOW-UP ON THE PROGNOSIS OF PATIENTS AND THE EVOLUTION OF LUPUS ACTIVITY

We studied the clinical course of 59 lupus patients with end-stage renal disease (ESRD) to determine their longterm prognosis and delineate the evolution of their lupus activity. The study population was predominantly female (86%) and young (mean age, 27.4 years), and they were observed for a mean of 6.5 years from the inception of dialysis. At the time dialysis was initiated, only 21 patients (35.6%) had clinically active systemic lupus erythematosus (SLE). The remaining patients progressed to ESRD despite the absence of clinical lupus activity. Lupus activity was clinically apparent in 55.4% of patients in the first year, 6.5% in the fifth, and none in the tenth year. In 45% of patients, lupus activity was clinically inactive at entry to ESRD and remained inactive throughout the observation period. Serological activity declined proportionally, but to a lesser extent than clinical activity. Cumulative patient survival was 81.1% and 74.6% at the fifth and tenth year, respectively, from the inception of dialysis treatment; similarly it was 78% at the fifth and tenth year after the transplantation. Graft survival was 60.4% at the fifth and 45.5% at the tenth year. No one had recurrence of clinical lupus nephritis in the graft for up to 16 years of follow-up. Fourteen patients died from either infectious or cardiovascular complications, but none from SLE per se. This long-term study with a large number of lupus patients confirms our previous findings that the progression of renal disease to ESRD may be mediated by nonimmunologic mechanisms, as well as immunologic insults. Most patients, regardless of the mode of treatment for ESRD, remain clinically quiescent for lupus activity despite persistent serological abnormalities. Patient survival, either on dialysis treatment or with a kidney transplant, is comparable to that of the general dialysis population. We conclude that in lupus patients with ESRD, regression of serological and clinical expression of SLE is continuous over time. Progressive resolution of lupus activity permits judicious withdrawal of immunosuppressive therapy, as well as a favorable long-term outcome of the patient. © 1990, National Kidney Foundation, Inc.. All rights reserved.