Conventional and Biological Disease-Modifying Antirheumatic Drugs in Chro-nic Kidney Disease and Hemodialysis

Advanced chronic kidney disease and the different modalities of renal replacement therapies have been a great limitation when prescribing the different conventional and biological therapies used for the treatment of different autoimmune diseases. Many of them persist with great activity, requiring the use of other types of medications such as glucocorticoids or non-steroidal anti-inflammatory drugs, further perpetuating their adverse effects. Addditionally, most clinical studies have excluded patients with chronic kidney disease and the evidence for continuing biological treatments in this scenario is based on pharmacokinetic properties or case reports where the outcomes have been favorable. The lack of knowledge and the absence of clear guidelines for decision-making regarding starting conventional or biological therapy in this context generate a lack of continuity in the prescription of treatments, which decreases the therapeutic response and negatively affects the quality of life. from the patients. For this reason, a narrative review is carried out with the aim of establishing a practical consensus that unifies the recommendations for each of the treatments most frequently used in the control of various autoimmune diseases in patients with advanced chronic kidney disease.