How do you use hydroxychloroquine in patients with lupus nephritis on hemodialysis or peritoneal dialysis?

After starting dialysis, other lupus manifestations frequently become clinically inactive. However, there is still a subset of patients who have clinical or serologic activity. Prior studies have shown that < 6% of lupus patients remain clinically active 5 years after starting dialysis, < 25% remain serologically active (1). However, other studies have shown either clinical or serologic activity persists in 50% or more even after starting dialysis (2). I continue hydroxychloroquine in patients o...

Personal experience:

I had a 70+ yo male patient that developed lupus and lupus nephritis (biopsy proven) at an older age (family history + in siblings). He was not on dialysis but treated with steroids and Cellcept and I chose 200 mg Hydroxychloroquine. He developed retinal toxicity after a short period, that resolved after discontinuing Hydroxychloroquine. He had normal eye exam, no diabetes. We don’t see males in elderly age group often with SLE but we have to be aware of toxicity in this vul...