Assessment of lupus activity for Egyptian patients on regular hemodialysis, is there a need for prolonged immunosuppressive therapy?

摘要

BackgroundEnd stage renal disease can decrease lupus activity especially after renal replacement therapy, so assessment of activity after starting hemodialysis (HD) is essential to avoid immunosuppressive complications and prevent flares.Aim of the workTo assess lupus activity in patients on regular HD and determine the differences in activity and number of lupus flares between patients who were maintained on steroids and immunosuppressives and those not.Patients and methodsThirty-five systemic lupus erythematosus (SLE) patients on regular HD. were recruited from 14 hemodialysis centers in five cities in Gharbia Governorate, Egypt. The patient?s files were reviewed and SLE disease activity index (SLEDAI) was measured.ResultsThe mean age of patients was 30.7?±?9.2?years and were 29 females and 6 males with a median disease duration of 6?years and SLEDAI of 3. 57.1% of the cases did not record lupus flare after dialysis while 42.9% were active; 11 (31.4%) of them had 1 flare, 3 (8.6%) had 2 flares and 1 (2.9%) had 3 flares. and according to the SLEDAI grading, 77.2% had no flare, 11.4% had mild flare and 11.4% moderate; none had a severe flare. There was no significant difference between those maintained on steroids or immunosuppressives and patients who stopped treatment after HD as regard number of flares and disease activity grading.ConclusionsLupus activity is not uncommon after starting hemodialysis but giving a prolonged immunosuppressive therapies is not necessary in all cases and should be given cautiously to avoid their side effects.