Continued treatment for lupus may boost survival of those patients with end-stage kidney disease

At least 1.5 million Americans (more than 90 percent of them women) have lupus (officially known as lupus erythematosus), a chronic autoimmune disease that can damage many organs of the body. Treatment usually involves using immunosuppressive drugs to blunt the immune system's attack on the body. Kidney disease is a common complication of lupus, and up to 30 percent of patients with lupus-related kidney disease ultimately develop end-stage renal failure.

“The lupus disease process was thought to become inactive once kidney failure develops,” said lead author Anna Broder, M.D., assistant professor of medicine at Einstein. “As a result, patients generally haven't been encouraged to continue with immunosuppressant medications or to follow up with their rheumatologists after developing end-stage kidney disease. But recent studies have suggested that lupus can indeed remain active after patients start dialysis or receive a kidney transplant.”

“Our research shows for the first time that under-supervising and under-treating these lupus patients was associated with an increased risk of death,” said Dr. Broder.

The Einstein researchers reviewed the charts of 80 lupus patients with end-stage renal disease who had been started on renal replacement therapy (i.e., either kidney dialysis or kidney transplant). Twenty-two of the patients had been seen frequently in rheumatology clinics (two or more visits per year), while the other 58 patients had been followed infrequently (fewer than two visits per year).

Four years after beginning renal replacement therapy, patients who continued to be treated with immunosuppressive medications were less likely to have died compared with patients who took only low doses of prednisone or no medication. (In fact, patients receiving no medication were 13 times more likely to have died compared with patients treated with a combination of immunosuppressive therapies.) The study also found that lupus patients who visited their rheumatologist at least twice a year after starting dialysis had significantly higher four-year survival rates compared with patients who went for fewer follow-up visits.

“If these findings are confirmed by future studies,” said Dr. Broder, “they may significantly change the way lupus patients with end-stage renal failure are managed while on dialysis or after receiving kidney transplants.”

Other authors of the study, “Under-treatment of disease activity in lupus patients with end-stage renal failure is associated with increased all-cause mortality,” were Saakshi Khattri, M.D., Montefiore Medical Center; Ruchi Patel, M.D., Jacobi Medical Center; and senior author Chaim Putterman, M.D., professor of medicine and chief of rheumatology at Einstein. This research was supported in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, part of the National Institutes of Health.

About Albert Einstein College of Medicine of Yeshiva University

Albert Einstein College of Medicine of Yeshiva University is one of the nation's premier centers for research, medical education and clinical investigation. During the 2009-2010 academic year, Einstein is home to 722 M.D. students, 243 Ph.D.students, 128 students in the combined M.D./Ph.D. program, and approximately 350 postdoctoral research fellows. The College of Medicine has 2,775 fulltime faculty members located on the main campus and at its clinical affiliates. In 2009, Einstein received more than $155 million in support from the NIH. This includes the funding of major research centers at Einstein in diabetes, cancer, liver disease, and AIDS. Other areas where the College of Medicine is concentrating its efforts include developmental brain research, neuroscience, cardiac disease, and initiatives to reduce and eliminate ethnic and racial health disparities. Through its extensive affiliation network involving five medical centers in the Bronx, Manhattan and Long Island – which includes Montefiore Medical Center, The University Hospital and Academic Medical Center for Einstein – the College of Medicine runs one of the largest post-graduate medical training programs in the United States, offering approximately 150 residency programs to more than 2,500 physicians in training. For more information, please visit www.einstein.yu.edu