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Journal article
A Longitudinal Analysis of Outcomes of Lupus Nephritis in an International Inception Cohort Using a Multistate Model Approach
Arthritis & rheumatology (Hoboken, N.J.), v 68(8), pp 1932-1944
Aug 2016
PMID: 26991067
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
To study bidirectional change and predictors of change in estimated glomerular filtration rate (GFR) and proteinuria in lupus nephritis (LN) using a multistate modeling approach.
Patients in the Systemic Lupus International Collaborating Clinics inception cohort were classified annually into estimated GFR state 1 (>60 ml/minute), state 2 (30-60 ml/minute), or state 3 (<30 ml/minute) and estimated proteinuria state 1 (<0.25 gm/day), state 2 (0.25-3.0 gm/day), or state 3 (>3.0 gm/day), or end-stage renal disease (ESRD) or death. Using multistate modeling, relative transition rates between states indicated improvement and deterioration.
Of 1,826 lupus patients, 700 (38.3%) developed LN. During a mean ± SD follow-up of 5.2 ± 3.5 years, the likelihood of improvement in estimated GFR and estimated proteinuria was greater than the likelihood of deterioration. After 5 years, 62% of patients initially in estimated GFR state 3 and 11% of patients initially in estimated proteinuria state 3 transitioned to ESRD. The probability of remaining in the initial states 1, 2, and 3 was 85%, 11%, and 3%, respectively, for estimated GFR and 62%, 29%, and 4%, respectively, for estimated proteinuria. Male sex predicted improvement in estimated GFR states; older age, race/ethnicity, higher estimated proteinuria state, and higher renal biopsy chronicity scores predicted deterioration. For estimated proteinuria, race/ethnicity, earlier calendar years, damage scores without renal variables, and higher renal biopsy chronicity scores predicted deterioration; male sex, presence of lupus anticoagulant, class V nephritis, and mycophenolic acid use predicted less improvement.
In LN, the expected improvement or deterioration in renal outcomes can be estimated by multistate modeling and is preceded by identifiable risk factors. New therapeutic interventions for LN should meet or exceed these expectations.
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Details
- Title
- A Longitudinal Analysis of Outcomes of Lupus Nephritis in an International Inception Cohort Using a Multistate Model Approach
- Creators
- John G Hanly - Queen Elizabeth II Health Sciences CentreLi Su - University of CambridgeMurray B Urowitz - Toronto Western HospitalJuanita Romero-Diaz - Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránCaroline Gordon - University of BirminghamSang-Cheol Bae - Hanyang University Seoul HospitalSasha Bernatsky - McGill University Health CentreAnn E Clarke - University of CalgaryDaniel J Wallace - Cedars-Sinai Medical CenterJoan T Merrill - Oklahoma Medical Research FoundationDavid A Isenberg - University College LondonAnisur Rahman - University College LondonEllen M Ginzler - SUNY Downstate Health Sciences UniversityMichelle Petri - Johns Hopkins MedicineIan N Bruce - Manchester Academic Health Science CentreM A Dooley - University of North Carolina at Chapel HillPaul Fortin - Université LavalDafna D Gladman - Toronto Western HospitalJorge Sanchez-Guerrero - Toronto Western HospitalKristjan Steinsson - Reykjavík UniversityRosalind Ramsey-Goldman - Northwestern UniversityMunther A Khamashta - St Thomas' HospitalCynthia Aranow - Feinstein Institute for Medical ResearchGraciela S Alarcón - University of Alabama at BirminghamBarri J Fessler - University of Alabama at BirminghamSusan Manzi - University of PittsburghOla Nived - Lund UniversityGunnar K Sturfelt - Lund UniversityAsad A Zoma - Hairmyres HospitalRonald F van Vollenhoven - Karolinska InstitutetManuel Ramos-Casals - Consorci Institut D'Investigacions Biomediques August Pi I SunyerGuillermo Ruiz-Irastorza - BioCruces Health research InstituteS Sam Lim - Emory UniversityKenneth C Kalunian - University of California, San DiegoMurat Inanc - Istanbul UniversityDiane L Kamen - Medical University of South CarolinaChristine A Peschken - University of ManitobaSoren Jacobsen - Copenhagen University HospitalAnca Askanase - New York University Langone Orthopedic HospitalChris Theriault - Queen Elizabeth II Health Sciences CentreVernon Farewell - University of Cambridge
- Publication Details
- Arthritis & rheumatology (Hoboken, N.J.), v 68(8), pp 1932-1944
- Publisher
- Wiley
- Grant note
- M01 RR000046 / NCRR NIH HHS UL1 TR000150 / NCATS NIH HHS Wellcome Trust MC_U105261167 / Medical Research Council UL1 RR025741 / NCRR NIH HHS P60 AR048098 / NIAMS NIH HHS MOP-86526 / CIHR P60 AR064464 / NIAMS NIH HHS K24 AR002128 / NIAMS NIH HHS R01 AR043727 / NIAMS NIH HHS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- General Internal Medicine
- Web of Science ID
- WOS:000383498400018
- Scopus ID
- 2-s2.0-84979578756
- Other Identifier
- 991021933908004721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Rheumatology