A Longitudinal Analysis of Outcomes of Lupus Nephritis in an International Inception Cohort Using a Multistate Model Approach

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A Longitudinal Analysis of Outcomes of Lupus Nephritis in an International Inception Cohort Using a Multistate Model Approach

Hanly, John G. (author): Dalhousie University

Su, Li (author): University of Cambridge

Urowitz, Murray B. (author): University of Toronto

Romero-Diaz, Juanita (author): Instituto Nacional de Ciencias Médicas y Nutrición

Gordon, Caroline (author): University of Birmingham

Bae, Sang Cheol (author): Hanyang University

Bernatsky, Sasha (author): McGill University

Clarke, Ann E. (author): University of Calgary

Wallace, Daniel J. (author): Cedars-Sinai Medical Center

Merrill, Joan T. (author): Oklahoma Medical Research Foundation

Isenberg, David A. (author): Royal Free Hospital

Rahman, Anisur (author): Royal Free Hospital

Ginzler, Ellen M. (author): SUNY Downstate Health Sciences University

Petri, Michelle (author): Johns Hopkins University School of Medicine

Bruce, Ian N. (author): University of Manchester

Dooley, M. A. (author): University of North Carolina

Fortin, Paul (author): Laval University

Gladman, Dafna D. (author): University of Toronto

Sanchez-Guerrero, Jorge (author): University of Toronto

Steinsson, Kristjan (author): National University Hospital of Iceland

Ramsey-Goldman, Rosalind (author): Northwestern University

Khamashta, Munther A. (author): Guy's and St Thomas' NHS Foundation Trust

Aranow, Cynthia (author): Feinstein Institute for Medical Research

Alarcón, Graciela S. (author): University of Alabama

Fessler, Barri J. (author): University of Alabama

Manzi, Susan (author): University of Pittsburgh

Nived, Ola (author): Lund University,Lunds universitet,Reumatologi och molekylär skelettbiologi,Sektion III,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Rheumatology,Section III,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital

Sturfelt, Gunnar K. (author): Lund University,Lunds universitet,Reumatologi och molekylär skelettbiologi,Sektion III,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Rheumatology,Section III,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital

Zoma, Asad A. (author): Hairmyres Hospital

van Vollenhoven, Ronald F. (author): Karolinska Institutet,Karolinska Institute

Ramos-Casals, Manuel (author): Hospital Clínic of Barcelona

Ruiz-Irastorza, Guillermo (author): University of the Basque Country

Lim, S. Sam (author): Emory University

Kalunian, Kenneth C. (author): University of California, San Diego

Inanc, Murat (author): Istanbul University

Kamen, Diane L. (author): Medical University of South Carolina

Peschken, Christine A. (author): University of Manitoba

Jacobsen, Soren (author): Copenhagen University Hospital

Askanase, Anca (author): Indian Institute of Technology

Theriault, Chris (author): Dalhousie University

Farewell, Vernon (author): University of Cambridge

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(creator_code:org_t)

2016-07-27
2016
English 13 s.
In: Arthritis & Rheumatology. - : Wiley. - 2326-5191 .- 2326-5205. ; 68:8, s. 1932-1944

Related links:: http://dx.doi.org/10...; show more...; https://europepmc.or...; https://lup.lub.lu.s...; https://doi.org/10.1...; http://kipublication...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

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 (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.

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By the author/editor: Hanly, John G.; Su, Li; Urowitz, Murray ...; Romero-Diaz, Jua ...; Gordon, Caroline; Bae, Sang Cheol; show more...; Bernatsky, Sasha; Clarke, Ann E.; Wallace, Daniel ...; Merrill, Joan T.; Isenberg, David ...; Rahman, Anisur; Ginzler, Ellen M ...; Petri, Michelle; Bruce, Ian N.; Dooley, M. A.; Fortin, Paul; Gladman, Dafna D ...; Sanchez-Guerrero ...; Steinsson, Krist ...; Ramsey-Goldman, ...; Khamashta, Munth ...; Aranow, Cynthia; Alarcón, Graciel ...; Fessler, Barri J ...; Manzi, Susan; Nived, Ola; Sturfelt, Gunnar ...; Zoma, Asad A.; van Vollenhoven, ...; Ramos-Casals, Ma ...; Ruiz-Irastorza, ...; Lim, S. Sam; Kalunian, Kennet ...; Inanc, Murat; Kamen, Diane L.; Peschken, Christ ...; Jacobsen, Soren; Askanase, Anca; Theriault, Chris; Farewell, Vernon; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Rheumatology and ...

Articles in the publication: Arthritis & Rheu ...

By the university: Lund University; Karolinska Institutet

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A Longitudinal Analysis of Outcomes of Lupus Nephritis in an International Inception Cohort Using a Multistate Model Approach

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