Optimal strategies for managing lupus medications after end-stage renal disease (ESRD) have not been addressed. This study identifies the current United States-wide prescribing patterns of hydroxychloroquine (HCQ) and oral corticosteroids (CS), among SLE patients with incident ESRD enrolled in the US Renal Disease Systems (USRDS) registry.
We identified incident ESRD patients ≥18 years with SLE as a primary cause of ESRD between January 2006 and June 2013. Patients who were started on dialysis at ESRD onset and enrolled in Medicare Part D within 93 days as required by Medicare were included.
Among the 2654 new-onset ESRD patients with Part D, the median (IQR) duration of follow-up was 761 (374, 1375) days. At baseline, 1076 (41%) were not on HCQ or CS, 220 (8%) were prescribed HCQ alone, 509 (19%) were prescribed both HCQ and CS, and 849 (32%) were prescribed CS alone. Of the 1983 patients who either never received or discontinued HCQ after ESRD onset, 667 (34%) continued CS to the end of the follow-up period. The median (IQR) CS dose was lower for patients on HCQ (14 [9, 21] mg), compared to patients who were never prescribed HCQ (15 [9, 27] mg), or patients who discontinued HCQ after ESRD (17 [10, 27] mg), p=0.001.
About one third of patients with lupus nephritis and new onset ESRD received CS monotherapy at high doses. As CS-related complications contribute to hospitalizations and deaths in SLE ESRD, changing these prescribing practices may improve morbidity and mortality outcomes.