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A Longitudinal Analysis of Outcomes of Lupus Nephritis in an International Inception Cohort Using a Multistate Model Approach
Author(s) -
Hanly John G.,
Su Li,
Urowitz Murray B.,
RomeroDiaz Juanita,
Gordon Caroline,
Bae SangCheol,
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.,
SanchezGuerrero Jorge,
Steinsson Kristjan,
RamseyGoldman 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.,
RamosCasals Manuel,
RuizIrastorza Guillermo,
Lim S. Sam,
Kalunian Kenneth C.,
Inanc Murat,
Kamen Diane L.,
Peschken Christine A.,
Jacobsen Soren,
Askanase Anca,
Theriault Chris,
Farewell Ver
Publication year - 2016
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.39674
Subject(s) - proteinuria , medicine , lupus nephritis , renal function , cohort , renal biopsy , systemic lupus erythematosus , urology , kidney , disease
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.