Factors associated with refractory renal disease in patients with systemic lupus erythematosus: the role of patient nonadherence

Arthritis Care Res. 2000 Dec;13(6):406-8.


Objective: To assess the prevalence and underlying reasons for the development of chronic renal insufficiency (CRI) in patients with systemic lupus erythematosus (SLE) seen over a 3-year period in our lupus clinic, in particular to determine the frequency and types of patient-dependent factors that were associated with nonadherence when it occurred.

Methods: We determined the frequency and types of patient-dependent factors that were associated with the development of CRI in patients with SLE. CRI was defined as a serum creatinine level > or = 200 mumol/l for at least 6 months.

Results: Of the 462 patients followed at the lupus clinic between 1995 and 1998, 17 patients developed CRI. Patient-related factors were deemed to be the major reason for the development of CRI in 5 of these. Three of the 5 patients were nonwhite, and the 2 patients who were white were new immigrants. All 5 patients were reluctant to take high-dose corticosteroids because of potential adverse effects. Financial problems contributed to nonadherence in 2 cases. Two patients refused to continue steroids and immunosuppressive therapy and chose to use "alternative" medications as their sole therapy. Of these 5 patients, 3 are now on long-term renal replacement therapy, 1 has died, and 1 patient continues to be followed with a serum creatinine level of 250 mumol/l.

Conclusion: There is a need for an educational program based on patients' cultural background in order to enhance patients' understanding of the aims, risks, and benefits of therapy in SLE.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Inflammatory Agents / therapeutic use
  • Biopsy
  • Complementary Therapies
  • Creatinine / blood
  • Educational Status
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / etiology*
  • Lupus Erythematosus, Systemic / complications*
  • Lupus Erythematosus, Systemic / drug therapy*
  • Lupus Erythematosus, Systemic / psychology
  • Lupus Nephritis / diagnosis
  • Lupus Nephritis / epidemiology
  • Lupus Nephritis / etiology*
  • Needs Assessment
  • Ontario / epidemiology
  • Patient Education as Topic
  • Prevalence
  • Prognosis
  • Prospective Studies
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • Treatment Refusal / psychology*
  • Treatment Refusal / statistics & numerical data
  • Unemployment / statistics & numerical data


  • Anti-Inflammatory Agents
  • Immunosuppressive Agents
  • Creatinine