Time to renal disease and end-stage renal disease in PROFILE: A multiethnic lupus cohort

Graciela S. Alarcón, Gerald McGwin, Michelle Petri, Rosalind Ramsey-Goldman, Barri J. Fessler, Luis M. Vilá, Jeffrey C. Edberg, John D. Reveille, Robert P. Kimberly

Research output: Contribution to journalArticle

Abstract

Background: Renal involvement is a serious manifestation of systemic lupus erythematosus (SLE); it may portend a poor prognosis as it may lead to end-stage renal disease (ESRD). The purpose of this study was to determine the factors predicting the development of renal involvement and its progression to ESRD in a multi-ethnic SLE cohort (PROFILE). Methods and Findings: PROFILE includes SLE patients from five different United States institutions. We examined at baseline the socioeconomic-demographic, clinical, and genetic variables associated with the development of renal involvement and its progression to ESRD by univariable and multivariable Cox proportional hazards regression analyses. Analyses of onset of renal involvement included only patients with renal involvement after SLE diagnosis (n = 229). Analyses of ESRD included all patients, regardless of whether renal involvement occurred before, at, or after SLE diagnosis (34 of 438 patients). In addition, we performed a multivariable logistic regression analysis of the variables associated with the development of renal involvement at any time during the course of SLE. In the time-dependent multivariable analysis, patients developing renal involvement were more likely to have more American College of Rheumatology criteria for SLE, and to be younger, hypertensive, and of African-American or Hispanic (from Texas) ethnicity. Alternative regression models were consistent with these results. In addition to greater accrued disease damage (renal damage excluded), younger age, and Hispanic ethnicity (from Texas), homozygosity for the valine allele of FcγRIIIa (FCGR3A*GG) was a significant predictor of ESRD. Results from the multivariable logistic regression model that included all cases of renal involvement were consistent with those from the Cox model. Conclusions: Fcγ receptor genotype is a risk factor for progression of renal disease to ESRD. Since the frequency distribution of FCGR3A alleles does not vary significantly among the ethnic groups studied, the additional factors underlying the ethnic disparities in renal disease progression remain to be elucidated.

Original languageEnglish (US)
Pages (from-to)1949-1956
Number of pages8
JournalPLoS Medicine
Volume3
Issue number10
DOIs
StatePublished - Oct 2006

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Chronic Kidney Failure
Kidney
Systemic Lupus Erythematosus
Logistic Models
Hispanic Americans
Disease Progression
Alleles
Regression Analysis
Fc Receptors
Valine
Proportional Hazards Models
Ethnic Groups
African Americans
Genotype
Demography

ASJC Scopus subject areas

  • Medicine(all)

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Alarcón, G. S., McGwin, G., Petri, M., Ramsey-Goldman, R., Fessler, B. J., Vilá, L. M., ... Kimberly, R. P. (2006). Time to renal disease and end-stage renal disease in PROFILE: A multiethnic lupus cohort. PLoS Medicine, 3(10), 1949-1956. https://doi.org/10.1371/journal.pmed.0030396

Time to renal disease and end-stage renal disease in PROFILE : A multiethnic lupus cohort. / Alarcón, Graciela S.; McGwin, Gerald; Petri, Michelle; Ramsey-Goldman, Rosalind; Fessler, Barri J.; Vilá, Luis M.; Edberg, Jeffrey C.; Reveille, John D.; Kimberly, Robert P.

In: PLoS Medicine, Vol. 3, No. 10, 10.2006, p. 1949-1956.

Research output: Contribution to journalArticle

Alarcón, GS, McGwin, G, Petri, M, Ramsey-Goldman, R, Fessler, BJ, Vilá, LM, Edberg, JC, Reveille, JD & Kimberly, RP 2006, 'Time to renal disease and end-stage renal disease in PROFILE: A multiethnic lupus cohort', PLoS Medicine, vol. 3, no. 10, pp. 1949-1956. https://doi.org/10.1371/journal.pmed.0030396
Alarcón, Graciela S. ; McGwin, Gerald ; Petri, Michelle ; Ramsey-Goldman, Rosalind ; Fessler, Barri J. ; Vilá, Luis M. ; Edberg, Jeffrey C. ; Reveille, John D. ; Kimberly, Robert P. / Time to renal disease and end-stage renal disease in PROFILE : A multiethnic lupus cohort. In: PLoS Medicine. 2006 ; Vol. 3, No. 10. pp. 1949-1956.
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abstract = "Background: Renal involvement is a serious manifestation of systemic lupus erythematosus (SLE); it may portend a poor prognosis as it may lead to end-stage renal disease (ESRD). The purpose of this study was to determine the factors predicting the development of renal involvement and its progression to ESRD in a multi-ethnic SLE cohort (PROFILE). Methods and Findings: PROFILE includes SLE patients from five different United States institutions. We examined at baseline the socioeconomic-demographic, clinical, and genetic variables associated with the development of renal involvement and its progression to ESRD by univariable and multivariable Cox proportional hazards regression analyses. Analyses of onset of renal involvement included only patients with renal involvement after SLE diagnosis (n = 229). Analyses of ESRD included all patients, regardless of whether renal involvement occurred before, at, or after SLE diagnosis (34 of 438 patients). In addition, we performed a multivariable logistic regression analysis of the variables associated with the development of renal involvement at any time during the course of SLE. In the time-dependent multivariable analysis, patients developing renal involvement were more likely to have more American College of Rheumatology criteria for SLE, and to be younger, hypertensive, and of African-American or Hispanic (from Texas) ethnicity. Alternative regression models were consistent with these results. In addition to greater accrued disease damage (renal damage excluded), younger age, and Hispanic ethnicity (from Texas), homozygosity for the valine allele of FcγRIIIa (FCGR3A*GG) was a significant predictor of ESRD. Results from the multivariable logistic regression model that included all cases of renal involvement were consistent with those from the Cox model. Conclusions: Fcγ receptor genotype is a risk factor for progression of renal disease to ESRD. Since the frequency distribution of FCGR3A alleles does not vary significantly among the ethnic groups studied, the additional factors underlying the ethnic disparities in renal disease progression remain to be elucidated.",
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AB - Background: Renal involvement is a serious manifestation of systemic lupus erythematosus (SLE); it may portend a poor prognosis as it may lead to end-stage renal disease (ESRD). The purpose of this study was to determine the factors predicting the development of renal involvement and its progression to ESRD in a multi-ethnic SLE cohort (PROFILE). Methods and Findings: PROFILE includes SLE patients from five different United States institutions. We examined at baseline the socioeconomic-demographic, clinical, and genetic variables associated with the development of renal involvement and its progression to ESRD by univariable and multivariable Cox proportional hazards regression analyses. Analyses of onset of renal involvement included only patients with renal involvement after SLE diagnosis (n = 229). Analyses of ESRD included all patients, regardless of whether renal involvement occurred before, at, or after SLE diagnosis (34 of 438 patients). In addition, we performed a multivariable logistic regression analysis of the variables associated with the development of renal involvement at any time during the course of SLE. In the time-dependent multivariable analysis, patients developing renal involvement were more likely to have more American College of Rheumatology criteria for SLE, and to be younger, hypertensive, and of African-American or Hispanic (from Texas) ethnicity. Alternative regression models were consistent with these results. In addition to greater accrued disease damage (renal damage excluded), younger age, and Hispanic ethnicity (from Texas), homozygosity for the valine allele of FcγRIIIa (FCGR3A*GG) was a significant predictor of ESRD. Results from the multivariable logistic regression model that included all cases of renal involvement were consistent with those from the Cox model. Conclusions: Fcγ receptor genotype is a risk factor for progression of renal disease to ESRD. Since the frequency distribution of FCGR3A alleles does not vary significantly among the ethnic groups studied, the additional factors underlying the ethnic disparities in renal disease progression remain to be elucidated.

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