Lupus Nephritis, Dialysis, and Flares

Lupus Nephritis: Do Flares Happen on Dialysis?

Dialysis is a treatment for lupus nephritis that helps to take care of the body, maintain health, and give the kidneys space to heal. It does not, however, reduce flares.

Systemic Lupus Erythematosus (SLE) is an autoimmune disease that affects every organ system in the body. This includes the kidneys, which filter toxins and keep the bloodstream in balance. Most treatments for lupus reduce flares, which are increases in symptom frequency and severity in response to a trigger. Severe kidney disease caused by lupus is often treated using renal replacement therapies, which replace the function of the kidneys. Do these treatments reduce flares? Or, do they cause flares?

What is Renal Replacement Therapy?

Kidneys are vital organs, and damage done to them affects the entire body. Lupus Nephritis (LN) is the term for when inflammation caused by lupus severely damages structures in the kidneys known as nephrons. This kidney damage, which occurs in about 40-60% people with lupus, can lead to a loss of kidney function. Lupus causes other damage to the kidneys as well, including urinary tract infections, but in all cases, kidney damage and potential kidney failure is the source of the most serious symptoms of lupus.

The symptoms of lupus nephritis include fluid retention and swelling, joint pain, muscle pain, fever, high blood pressure, abnormal urine, and even the well-known malar rash of lupus. You can read more about kidney disease and lupus here. 

Lupus nephritis is very serious, but the treatments for it are very effective. 10-30% of people with LN develop end-stage renal disease and kidney failure, which increases their risk of death. As long as they do not enter renal failure, however, people with lupus can live normal, relatively healthy lives.

Renal replacement therapies are used to maintain their health and offset the damage to the body caused by nonfunctional kidneys. Dialysis is a form of renal replacement therapy that helps the body remove waste, salt, and extra water in the bloodstream. It also helps balance potassium and sodium, important chemicals for the body, and helps maintain blood pressure.  You can read more about it here.

Do Flares Happen While on Dialysis?

Yes. Disease flares can occur even while on dialysis, a renal replacement therapy where treatments (including machines) stand in for failing kidneys and filter the blood. It does not appear to reduce flares, though. People who experienced flares were also likely to experience flares under renal replacement therapy. 

In a study on 121 patients with SLE on dialysis (both hemodialysis and peritoneal dialysis) 26.4% of them experienced an SLE flare. Most of these people were treated with cortiosteroids, and 34.3% of people took additional immunosuppressants to combat disease symptoms and flares. Flares included fevers, thrombocytopenia (low platelet count,) and leukopenia (abnormal levels of white blood cells in the bloodstream.) Both of these are clear markers of increased inflammation and are expected in cases of flares.

Flares can occur right after dialysis, possibly caused by the dialysis itself, which does stress the body. Fatigue is a known side effect of hemodialysis though researchers are not entirely sure why.

Reducing Flares on Dialysis

Renal replacement therapies take on the function of the kidneys, removing waste products and maintaining a balance of dissolved materials and fluid in the  bloodstream. Doctors try to minimize reactions to dialysis by having it done in several short, intermittent sessions. This reduces the stress on the body and potential for flare triggering events.  For more severe acute renal failure, continuous dialysis has to be used, which can be harder on the body, but is necessary.

Most people with lupus are not using dialysis to control flares, but to avoid the symptoms of renal failure. Instead, they use immunosuppressive therapy, a key treatment for lupus nephritis, to reduce inflammation and avoid symptom flares.

People with lupus are also advised to drink plenty of water and stay hydrated. This helps to maintain good kidney health and takes some of the pressure off of the kidneys. It also has many other health benefits.

Dialysis is not necessarily forever! 28% of people with lupus nephritis restore enough kidney function to come off of dialysis. Keeping up the treatment is key and will reduce flares.