Objectives: In this study, we performed a systematic literature review and meta-analysis to assess the frequency of Systemic Lupus Erythematosus (SLE) flares in patients with ESRD and patients undergoing renal replacement therapy (RRT) (hemodialysis (HD), peritoneal dialysis (PD), and kidney transplant (KT).
Methods: Literature from 1973 to 2023 was searched for studies on the frequency of lupus flares after RRT. Data were extracted for ESRD and each RRT modality. Forest plots and random effect models were used to evaluate the odds ratios (95% CI) of SLE flares after ESRD or RRT, and study heterogeneity was assessed using I statistics.
Results: 57 studies fulfilled the study entry criteria. 29 studies evaluated extra-renal SLE flares after HD/PD and 5 studies evaluated extra-renal SLE flares after KT. The frequency of extra-renal SLE flares was compared between HD and PD in 7 studies, and between HD/PD and KT in 4. The recurrence of lupus nephritis (LN) was analyzed in 29 studies. Overall, 35.9% of patients with ESRD had at least one extra-renal flare after RRT. The frequency of extra-renal SLE flare was similar in PD and HD (OR: 1.05, 95% CI: 0.57-1.94). Extra-renal flare risk was significantly higher in the PD/HD group compared to KT (OR: 4.36, 95%CI: 1.66-11.47, p=0.0028). The recurrence of LN after KT was 3.39%.
Conclusions: Extra-renal lupus flares can still occur in more than one-third of patients with ESRD on RRT. Dialysis patients have a higher flare risk than those post-KT, with comparable flare risk among patients on HD and PD.
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