Regarding the comments made by Mejía-Vilet of the recommendations in the guidelines1 with respect to the substitution of renal function in patients who develop end-stage renal disease due to lupus nephritis we coincide, and this is stated in the document, that the best option is renal transplantation. The evidence shows that this intervention is superior to hemodialysis or peritoneal dialysis,2 providing the patient with a better opportunity for survival in the median and long term, as well as reducing comorbidities and increasing life expectancy.

Regarding the comparison between hemodialysis and peritoneal dialysis, as stated in this letter, published evidence has been contradictory and depends on the population, comorbidities,3 resources and quality or conditions of the procedures. Although we do recognize the evidence provided by Contreras et al.4 in the US population that did not show differences between both treatment modalities, the recommendation to prefer hemodialysis instead of peritoneal dialysis when possible was based, as stated in the document, on an albeit small study, but one that coincides with many of the characteristics in our clinical environment. We agree that the best option should in any case be individualized based on patient characteristics and resource availability.