Kidney Failure? Keep Treating Your Lupus

Lupus patients with end stage kidney disease should stay on lupus treatment plan

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Lupus is a disease that can harm many parts of the body, and even end up causing kidney failure. Researchers have found a way to improve the survival of these patients.

Lupus patients with end-stage kidney disease (the complete, or near complete failure of the kidneys) who are treated with immunosuppressant drugs and closely supervised by experts have a lower risk of death compared to those who take low doses or no medication.

"Keep up your lupus treatment if you have kidney failure."

With this finding, Anna Broder, M.D., from Albert Einstein College of Medicine of Yeshiva University, and colleagues may reverse the long-established practices for treating lupus patients who have lost kidney function.

Lupus is an autoimmune disease, meaning that it occurs when a person's immune system attacks the body. The disease is usually treated using immunosuppressant drugs, or drugs that stop the immune system's attack on the body.

Kidney disease often results from lupus. As much as 30 percent of lupus patients with kidney disease will go on to develop end-stage kidney failure.

It was thought that lupus became inactive once a patient developed kidney failure, says Dr. Broder. Consequently, doctors did not encourage these patients to keep taking their immunosuppressant drugs nor to keep seeing a lupus expert once they had end-stage kidney disease.

Dr. Broder explains that recent studies have suggested that lupus is still taking its toll on patients after they start dialysis (a process to filter the blood) or get a kidney transplant.

The study by Dr. Broder and colleagues is the first to show that lupus patients with kidney failure are not getting the supervision and treatment they need. In fact, this under-treatment is associated with a higher risk of death.

For their study, the researchers looked at the medical records of 80 lupus patients with end-stage kidney disease who were either on dialysis or had received a kidney transplant. They saw that 22 of the patients made frequent visits to lupus experts at rheumatology clinics (at least two visits per year). The other 58 patients did not make frequent visits to the clinic (less than two visits per year).

The researchers found that lupus patients who visited a rheumatologist two or more times a year after starting dialysis had much better survival rates at the end of four years, compared to those who went less than twice a year.

They also found that patients who kept taking immunosuppressant drugs after starting dialysis or getting a transplant were less likely to die compared to those who took low doses of the immunosuppressant drug prednisone (marketed as Deltasone, Liquid Pred, Meticorten, Orasone, and others). Patients who took no drugs at all were 13 times more likely to die than patients who stayed on their immunosuppressive treatments.

This research was supported in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. The full results of the observational study are published in the Journal of Rheumatology.  

Reviewed by: 
Review Date: 
September 21, 2011
Last Updated:
October 21, 2012