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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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Authors
Hanly, John G
Su, Li
Urowitz, Murray B
Romero-Diaz, Juanita
Gordon, Caroline
Bae, Sang-Cheol
Bernatsky, Sasha
Clarke, Ann E
Wallace, Daniel J
Merrill, Joan T
Isenberg, David A
Rahman, Anisur
Ginzler, Ellen M
Petri, Michelle
Bruce, Ian N
Dooley, M A
Fortin, Paul
Gladman, Dafna D
Sanchez-Guerrero, Jorge
Steinsson, Kristjan
Ramsey-Goldman, Rosalind
Khamashta, Munther A
Aranow, Cynthia
Alarcón, Graciela S
Fessler, Barri J
Manzi, Susan
Nived, Ola
Sturfelt, Gunnar K
Zoma, Asad A
van Vollenhoven, Ronald F
Ramos-Casals, Manuel
Ruiz-Irastorza, Guillermo
Lim, S Sam
Kalunian, Kenneth C
Inanc, Murat
Kamen, Diane L
Peschken, Christine A
Jacobsen, Soren
Askanase, Anca
Theriault, Chris
Farewell, Vernon
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Issue Date
2016-08

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A Longitudinal Analysis of Outcomes of Lupus Nephritis in an International Inception Cohort Using a Multistate Model Approach. 2016, 68 (8):1932-44notArthritis Rheumatol
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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Additional Links
http://dx.doi.org/ 10.1002/art.39674
http://onlinelibrary.wiley.com/doi/10.1002/art.39674/pdf
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Archived with thanks to Arthritis & rheumatology (Hoboken, N.J.)
ae974a485f413a2113503eed53cd6c53
10.1002/art.39674
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English Journal Articles (Peer Reviewed)

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