Overall survival is comparable among patients with and without systemic lupus erythematosus (SLE) who initiate kidney replacement therapy (KRT), according to new research. Infection-related mortality, however, may be higher for the SLE population.

Using data from the 1992-2016 European Renal Association (ERA) registry, investigators matched 1056 patients with SLE to 5280 patients without SLE who initiated KRT. In an adjusted analysis, overall survival after KRT did not differ significantly between patients with and without SLE, Anneke Kramer, PhD, of the ERA Registry in Amsterdam, the Netherlands, and colleagues reported in the American Journal of Kidney Diseases. After their first kidney transplantation, patients with SLE had a significant 25% increased risk for death. The risk for all-cause graft failure appeared similar.

According to Dr Kramer’s team, SLE’s unfavorable effect on overall patient survival after kidney transplantation “may be caused by disease-specific complications but may also in part be due to complications arising from long-term immunosuppressive burden.”

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Infection-related mortality was significantly higher among patients with than without SLE receiving KRT: 24.8% vs 16.9%.

“The higher risk of infectious diseases associated with immunosuppressive therapy might partly explain this increased mortality in SLE patients on KRT,” the investigators wrote.

The incidence of patients with SLE on KRT remained stable from 1992 to 2016. Ten-year patient overall survival on KRT significantly improved by 29%. Patient survival and graft survival after kidney transplantation significantly improved by 57% and 40%, respectively.


Derner O, Kramer A, Hruskova Z, et al. Incidence of kidney replacement therapy and subsequent outcomes among patients with systemic lupus erythematosus: findings from the ERA Registry. Am J Kid Dis. Published online November 6, 2021. doi:10.1053/j.ajkd.2021.09.016