Do you generally prefer to continue hydroxychloroquine in lupus patients who develop ESRD despite the low likelihood of clinically active disease in this patient population?  

Yes, I do. In my experience, nephrologists tend to forget or neglect the use of HCQ. HCQ can prevent lupus flare-ups and progression of disease not to mention CV benefits as well as being helpful in addressing APS if present.

I usually continue hydroxychloroquine for lupus patients who develop renal failure. It is important to adjust the dose to address reduced HCQ clearance in renal failure. This is best accomplished by obtaining a hydroxychloroquine level. Often, patients who develop renal failure from lupus nephritis ...

I think I care for a different subset of patients than you do. My patients with ESRD from LN still often have active SLE in terms of joints, and skin. Not to mention the outcomes of thrombosis, and cardiovascular impact.

A significant portion of SLE patients with ESRD will get extrarenal disease, and therefore, I keep patients on hydroxychloroquine in this setting.