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...

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 p...