Factors associated with refractory renal disease in patients with systemic lupus erythematosus: the role of patient nonadherence.
OBJECTIVE
To assess the prevalence and underlying reasons for the development of chronic renal insufficiency (CRI) in patients with systemic lupus erythematosus (SLE) seen over a 3-year period in our lupus clinic, in particular to determine the frequency and types of patient-dependent factors that were associated with nonadherence when it occurred.


METHODS
We determined the frequency and types of patient-dependent factors that were associated with the development of CRI in patients with SLE. CRI was defined as a serum creatinine level > or = 200 mumol/l for at least 6 months.


RESULTS
Of the 462 patients followed at the lupus clinic between 1995 and 1998, 17 patients developed CRI. Patient-related factors were deemed to be the major reason for the development of CRI in 5 of these. Three of the 5 patients were nonwhite, and the 2 patients who were white were new immigrants. All 5 patients were reluctant to take high-dose corticosteroids because of potential adverse effects. Financial problems contributed to nonadherence in 2 cases. Two patients refused to continue steroids and immunosuppressive therapy and chose to use "alternative" medications as their sole therapy. Of these 5 patients, 3 are now on long-term renal replacement therapy, 1 has died, and 1 patient continues to be followed with a serum creatinine level of 250 mumol/l.


CONCLUSIONS
There is a need for an educational program based on patients' cultural background in order to enhance patients' understanding of the aims, risks, and benefits of therapy in SLE.
Bruce
I N
IN
Centre for Prognosis Studies in the Rheumatic Diseases, 1-319 Main Pavilion, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, Ontario, M5T 2S8 Canada.
Gladman
D D
DD
Urowitz
M B
MB
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001706:Biopsy; D000529:Complementary Therapies; D003404:Creatinine / Q000097:blood; D004522:Educational Status; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy* / Q000523:psychology; D008181:Lupus Nephritis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D020380:Needs Assessment; D009864:Ontario / Q000453:epidemiology; D010353:Patient Education as Topic; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D016312:Treatment Refusal / Q000523:psychology* / Q000706:statistics & numerical data; D014478:Unemployment / Q000706:statistics & numerical data
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D003404:Creatinine