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

John G. Hanly, Li Su, Murray B. Urowitz, Juanita Romero-Diaz, Caroline Gordon, Sang Cheol Bae, Sasha Bernatsky, Ann E. Clarke, Daniel J. Wallace, Joan T. Merrill, David A. Isenberg, Anisur Rahman, Ellen M. Ginzler, Michelle Petri, Ian N. Bruce, M. A. Dooley, Paul Fortin, Dafna D. Gladman, Jorge Sanchez-Guerrero, Kristjan SteinssonRosalind Ramsey-Goldman, Munther A. Khamashta, Cynthia Aranow, Graciela S. Alarcón, Barri J. Fessler, Susan Manzi, Ola Nived, Gunnar K. Sturfelt, 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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1932-1944
Number of pages13
JournalArthritis and Rheumatology
Volume68
Issue number8
DOIs
StatePublished - Aug 1 2016

Fingerprint

Lupus Nephritis
Glomerular Filtration Rate
Proteinuria
Kidney
Chronic Kidney Failure
Mycophenolic Acid
Biopsy
Lupus Coagulation Inhibitor
Nephritis

ASJC Scopus subject areas

  • Immunology
  • Immunology and Allergy
  • Rheumatology

Cite this

Hanly, J. G., Su, L., Urowitz, M. B., Romero-Diaz, J., Gordon, C., Bae, S. C., ... Farewell, V. (2016). A Longitudinal Analysis of Outcomes of Lupus Nephritis in an International Inception Cohort Using a Multistate Model Approach. Arthritis and Rheumatology, 68(8), 1932-1944. https://doi.org/10.1002/art.39674

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

In: Arthritis and Rheumatology, Vol. 68, No. 8, 01.08.2016, p. 1932-1944.

Research output: Contribution to journalArticle

Hanly, JG, Su, L, Urowitz, MB, Romero-Diaz, J, Gordon, C, Bae, SC, Bernatsky, S, Clarke, AE, Wallace, DJ, Merrill, JT, Isenberg, DA, Rahman, A, Ginzler, EM, Petri, M, Bruce, IN, Dooley, MA, Fortin, P, Gladman, DD, Sanchez-Guerrero, J, Steinsson, K, Ramsey-Goldman, R, Khamashta, MA, Aranow, C, Alarcón, GS, Fessler, BJ, Manzi, S, Nived, O, Sturfelt, GK, Zoma, AA, van Vollenhoven, RF, Ramos-Casals, M, Ruiz-Irastorza, G, Lim, SS, Kalunian, KC, Inanc, M, Kamen, DL, Peschken, CA, Jacobsen, S, Askanase, A, Theriault, C & Farewell, V 2016, 'A Longitudinal Analysis of Outcomes of Lupus Nephritis in an International Inception Cohort Using a Multistate Model Approach', Arthritis and Rheumatology, vol. 68, no. 8, pp. 1932-1944. https://doi.org/10.1002/art.39674
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. / A Longitudinal Analysis of Outcomes of Lupus Nephritis in an International Inception Cohort Using a Multistate Model Approach. In: Arthritis and Rheumatology. 2016 ; Vol. 68, No. 8. pp. 1932-1944.
@article{0cabd20a2611410fae2d2c3060386b95,
title = "A Longitudinal Analysis of Outcomes of Lupus Nephritis in an International Inception Cohort Using a Multistate Model Approach",
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.",
author = "Hanly, {John G.} and Li Su and Urowitz, {Murray B.} and Juanita Romero-Diaz and Caroline Gordon and Bae, {Sang Cheol} and Sasha Bernatsky and Clarke, {Ann E.} and Wallace, {Daniel J.} and Merrill, {Joan T.} and Isenberg, {David A.} and Anisur Rahman and Ginzler, {Ellen M.} and Michelle Petri and Bruce, {Ian N.} and Dooley, {M. A.} and Paul Fortin and Gladman, {Dafna D.} and Jorge Sanchez-Guerrero and Kristjan Steinsson and Rosalind Ramsey-Goldman and Khamashta, {Munther A.} and Cynthia Aranow and Alarc{\'o}n, {Graciela S.} and Fessler, {Barri J.} and Susan Manzi and Ola Nived and Sturfelt, {Gunnar K.} and Zoma, {Asad A.} and {van Vollenhoven}, {Ronald F.} and Manuel Ramos-Casals and Guillermo Ruiz-Irastorza and Lim, {S. Sam} and Kalunian, {Kenneth C.} and Murat Inanc and Kamen, {Diane L.} and Peschken, {Christine A.} and Soren Jacobsen and Anca Askanase and Chris Theriault and Vernon Farewell",
year = "2016",
month = "8",
day = "1",
doi = "10.1002/art.39674",
language = "English (US)",
volume = "68",
pages = "1932--1944",
journal = "Arthritis and Rheumatology",
issn = "2326-5191",
publisher = "John Wiley and Sons Ltd",
number = "8",

}

TY - JOUR

T1 - A Longitudinal Analysis of Outcomes of Lupus Nephritis in an International Inception Cohort Using a Multistate Model Approach

AU - Hanly, John G.

AU - Su, Li

AU - Urowitz, Murray B.

AU - Romero-Diaz, Juanita

AU - Gordon, Caroline

AU - Bae, Sang Cheol

AU - Bernatsky, Sasha

AU - Clarke, Ann E.

AU - Wallace, Daniel J.

AU - Merrill, Joan T.

AU - Isenberg, David A.

AU - Rahman, Anisur

AU - Ginzler, Ellen M.

AU - Petri, Michelle

AU - Bruce, Ian N.

AU - Dooley, M. A.

AU - Fortin, Paul

AU - Gladman, Dafna D.

AU - Sanchez-Guerrero, Jorge

AU - Steinsson, Kristjan

AU - Ramsey-Goldman, Rosalind

AU - Khamashta, Munther A.

AU - Aranow, Cynthia

AU - Alarcón, Graciela S.

AU - Fessler, Barri J.

AU - Manzi, Susan

AU - Nived, Ola

AU - Sturfelt, Gunnar K.

AU - Zoma, Asad A.

AU - van Vollenhoven, Ronald F.

AU - Ramos-Casals, Manuel

AU - Ruiz-Irastorza, Guillermo

AU - Lim, S. Sam

AU - Kalunian, Kenneth C.

AU - Inanc, Murat

AU - Kamen, Diane L.

AU - Peschken, Christine A.

AU - Jacobsen, Soren

AU - Askanase, Anca

AU - Theriault, Chris

AU - Farewell, Vernon

PY - 2016/8/1

Y1 - 2016/8/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84979578756&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84979578756&partnerID=8YFLogxK

U2 - 10.1002/art.39674

DO - 10.1002/art.39674

M3 - Article

C2 - 26991067

AN - SCOPUS:84979578756

VL - 68

SP - 1932

EP - 1944

JO - Arthritis and Rheumatology

JF - Arthritis and Rheumatology

SN - 2326-5191

IS - 8

ER -