TY - JOUR T1 - Disease Flare of Systemic Lupus Erythematosus in Patients With Endstage Renal Disease on Dialysis JF - The Journal of Rheumatology JO - J Rheumatol DO - 10.3899/jrheum.220101 SP - jrheum.220101 AU - Young-Eun Kim AU - Su Jin Choi AU - Doo-Ho Lim AU - Hyosang Kim AU - Soo Min Ahn AU - Ji Seon Oh AU - Yong-Gil Kim AU - Chang-Keun Lee AU - Bin Yoo AU - Seokchan Hong Y1 - 2022/08/15 UR - http://www.jrheum.org/content/early/2022/08/09/jrheum.220101.abstract N2 - Objective Although systemic lupus erythematosus (SLE) disease activity diminishes after starting dialysis, flares have been documented during dialysis. Hence, we studied the various clinical and therapeutic variables of patients with SLE who had a disease flare while on dialysis. Methods The medical records of patients with SLE who received dialysis at 2 tertiary referral hospitals in South Korea were reviewed. The disease activity was analyzed in terms of the nonrenal SLE Disease Activity Index (SLEDAI), and the factors associated with SLE flares were evaluated. Results Of the total of 121 patients with SLE on dialysis, 96 (79.3%) were on hemodialysis (HD) and 25 (20.7%) were on peritoneal dialysis (PD). During a median follow-up of 45 months (IQR 23-120) after the initiation of dialysis, 32 (26.4%) patients experienced an SLE flare (HD, n = 25; PD, n = 7). The most common features of SLE flare were hematologic (40.6%; thrombocytopenia [31.2%] and leukopenia [21.8%]) and constitutional manifestations (40.6%). Fever was the most common (34.3%) feature among the constitutional symptoms. Treatments for disease flares were based on corticosteroids, and 11 (34.3%) patients required additional immunosuppressants, including cyclophosphamide and mycophenolate mofetil. Nonrenal SLEDAI score before dialysis initiation (HR 1.24, 95% CI 1.12-1.36; P = 0.001) was a significant risk factor for disease flare during dialysis. Conclusion More than a quarter of the patients with SLE experienced a disease flare during dialysis, which most commonly had hematologic manifestations, particularly thrombocytopenia. Continued follow-up and appropriate treatments, including immunosuppressants, should be considered for patients with SLE receiving dialysis. ER -