Lupus Flares: More Common in Dialysis Patients Than in Post–Kidney Transplant Recipients: A Systematic Review and Meta-Analysis

Abstract

Objective: 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 end-stage renal disease (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% confidence interval [CI]) of SLE flares after ESRD or RRT, and study heterogeneity was assessed using I2 statistics. Results: A total of 57 studies fulfilled the study entry criteria. A total of 29 studies evaluated extrarenal SLE flares after HD/PD, and five studies evaluated extrarenal SLE flares after KT. The frequency of extrarenal SLE flares was compared between HD and PD in seven studies and between HD/PD and KT in four studies. The recurrence of lupus nephritis (LN) was analyzed in 29 studies. Overall, 35.9% of patients with ESRD had at least one extrarenal flare after RRT. The frequency of extrarenal SLE flare was similar in PD and HD (oods ratio [OR] 1.05, 95% CI 0.57–1.94). Extrarenal flare risk was significantly higher in the PD/HD group compared with that of the KT group (OR 4.36, 95% CI 1.66–11.47; P = 0.0028). The recurrence of LN after KT was 3.39%. Conclusion: Extrarenal lupus flares can still occur in more than one-third of patients with ESRD receiving RRT. Dialysis patients have a higher flare risk than those after KT, with comparable flare risk among patients receiving HD and PD.