John G Hanly1, Li Su2, Murray B Urowitz3, Juanita Romero-Diaz4, Caroline Gordon5, Sang-Cheol Bae6, Sasha Bernatsky7, Ann E Clarke8, Daniel J Wallace9, Joan T Merrill10, David A Isenberg11, Anisur Rahman11, Ellen M Ginzler12, Michelle Petri13, Ian N Bruce14, M A Dooley15, Paul Fortin16, Dafna D Gladman3, Jorge Sanchez-Guerrero3, Kristjan Steinsson17, Rosalind Ramsey-Goldman18, Munther A Khamashta19, Cynthia Aranow20, Graciela S Alarcón21, Barri J Fessler21, Susan Manzi22, Ola Nived23, Gunnar K Sturfelt23, Asad A Zoma24, Ronald F van Vollenhoven25, Manuel Ramos-Casals26, Guillermo Ruiz-Irastorza27, S Sam Lim28, Kenneth C Kalunian29, Murat Inanc30, Diane L Kamen31, Christine A Peschken32, Soren Jacobsen33, Anca Askanase34, Chris Theriault1, Vernon Farewell2. 1. Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada. 2. Institute of Public Health and University of Cambridge, University Forvie Site, Cambridge, UK. 3. Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada. 4. Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico. 5. University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK. 6. Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea. 7. McGill University Health Centre, Montreal, Quebec, Canada. 8. University of Calgary, Calgary, Alberta, Canada. 9. Cedars-Sinai Medical Center and University of California, Los Angeles, David Geffen School of Medicine. 10. Oklahoma Medical Research Foundation, Oklahoma City. 11. University College London, London, UK. 12. State University of New York Downstate Medical Center, Brooklyn. 13. Johns Hopkins University School of Medicine, Baltimore, Maryland. 14. Arthritis Research UK Epidemiology Unit, Manchester Academic Health Sciences Centre, University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, and Manchester Academic Health Science Centre, Manchester, UK. 15. University of North Carolina, Chapel Hill. 16. Centre Hospitalier Universitaire de Québec and Université Laval, Quebec City, Canada. 17. Landspitali University Hospital, Reykjavik, Iceland. 18. Northwestern University Feinberg School of Medicine, Chicago, Illinois. 19. The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK. 20. Feinstein Institute for Medical Research, Manhasset, New York. 21. University of Alabama at Birmingham. 22. University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. 23. University Hospital Lund, Lund, Sweden. 24. Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, UK. 25. Karolinska Institute, Stockholm, Sweden. 26. Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Barcelona, Spain. 27. BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain. 28. Emory University School of Medicine, Atlanta, Georgia. 29. University of California at San Diego, La Jolla. 30. Istanbul University, Istanbul, Turkey. 31. Medical University of South Carolina, Charleston. 32. University of Manitoba, Winnipeg, Manitoba, Canada. 33. Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. 34. Hospital for Joint Diseases, New York University, Seligman Centre for Advanced Therapeutics, New York, New York.
Abstract
OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Authors: Emily C Somers; Wendy Marder; Patricia Cagnoli; Emily E Lewis; Peter DeGuire; Caroline Gordon; Charles G Helmick; Lu Wang; Jeffrey J Wing; J Patricia Dhar; James Leisen; Diane Shaltis; W Joseph McCune Journal: Arthritis Rheumatol Date: 2014-02 Impact factor: 10.995
Authors: S Sam Lim; A Rana Bayakly; Charles G Helmick; Caroline Gordon; Kirk A Easley; Cristina Drenkard Journal: Arthritis Rheumatol Date: 2014-02 Impact factor: 10.995
Authors: G S Cooper; C G Parks; E L Treadwell; E W St Clair; G S Gilkeson; P L Cohen; R A S Roubey; M A Dooley Journal: Lupus Date: 2002 Impact factor: 2.911
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Authors: Michelle R Ugolini-Lopes; Luciana Parente C Seguro; Maitê Xavier F Castro; Danielle Daffre; Alex C Lopes; Eduardo F Borba; Eloisa Bonfá Journal: Lupus Sci Med Date: 2017-06-12
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Authors: Megan R W Barber; John G Hanly; Li Su; Murray B Urowitz; Yvan St Pierre; Juanita Romero-Diaz; Caroline Gordon; Sang-Cheol Bae; Sasha Bernatsky; Daniel J Wallace; David A Isenberg; Anisur Rahman; Ellen M Ginzler; Michelle Petri; Ian N Bruce; Paul R Fortin; Dafna D Gladman; Jorge Sanchez-Guerrero; Rosalind Ramsey-Goldman; Munther A Khamashta; Cynthia Aranow; Meggan Mackay; Graciela S Alarcón; Susan Manzi; Ola Nived; Andreas Jönsen; Asad A Zoma; Ronald F van Vollenhoven; Manuel Ramos-Casals; Guillermo Ruiz-Irastorza; S Sam Lim; Kenneth C Kalunian; Murat Inanc; Diane L Kamen; Christine A Peschken; Soren Jacobsen; Anca Askanase; Chris Theriault; Vernon Farewell; Ann E Clarke Journal: Arthritis Care Res (Hoboken) Date: 2018-08-17 Impact factor: 4.794
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