title: Improving outcomes in patients with lupus and end-stage renal disease.
abstract: The development of lupus-related end-stage renal disease (ESRD) confers the highest mortality rates among individuals with lupus. Lupus-related ESRD is also associated with higher morbidity and mortality rates compared with non-lupus ESRD. We review the evidence that persistent lupus activity, hypercoagulability, and continuing immunosuppression may contribute to unfavorable outcomes in dialysis and renal transplantation among lupus patients. Robust epidemiologic studies are needed to develop individualized evidence-based approaches to treating lupus-related ESRD. In the meantime, managing lupus-related ESRD presents a significant challenge for clinicians and requires a team approach involving nephrologists and rheumatologists. Goals of therapy after developing ESRD should include continuing monitoring of lupus activity, minimizing corticosteroid exposure, and choosing the most appropriate renal replacement therapy based on patient's risk profile and quality-of-life considerations.
authors.affiliation: Division of Nephrology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
authors.forename: Antonio
authors.initials: A
authors.lastname: Inda-Filho
authors.forename: Joel
authors.initials: J
authors.lastname: Neugarten
authors.forename: Chaim
authors.initials: C
authors.lastname: Putterman
authors.forename: Anna
authors.initials: A
authors.lastname: Broder
mesh_terms: D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000628:therapy; D016030:Kidney Transplantation; D008181:Lupus Nephritis / Q000503:physiopathology* / Q000628:therapy; D063868:Patient Outcome Assessment; D006435:Renal Dialysis; D016896:Treatment Outcome