Predictors of the start of declining eGFR in patients with systemic lupus erythematosus
| Autor: | Michelle Petri, Terry Cheuk-Fung Yip, Laurence S. Magder, Suchi Saria |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty 030232 urology & nephrology Urology Renal function Kidney Article 03 medical and health sciences 0302 clinical medicine Rheumatology Predictive Value of Tests Epidemiology medicine Humans Lupus Erythematosus Systemic In patient Longitudinal Studies Retrospective Studies 030203 arthritis & rheumatology business.industry Complement C4 Middle Aged Black or African American Proteinuria Hematocrit Creatinine Hypertension Multivariate Analysis Disease Progression Linear Models Prednisone Female business Glomerular Filtration Rate |
| Zdroj: | Lupus |
| ISSN: | 1477-0962 0961-2033 |
| Popis: | ObjectiveTo characterize the longitudinal trajectory of estimated glomerular filtration rate (eGFR) in patients with systemic lupus erythematosus (SLE) and identify predictors of the change in eGFR trajectory.MethodsThe longitudinal eGFR levels of patients in the Hopkins Lupus Cohort were modelled by piecewise linear regression to evaluate the slope of different line segments. The slopes were classified into declining (≤−4 mL/min/1.73 m2per year), stable (−4 to 4 mL/min/1.73 m2per year), and increasing (≥4 mL/min/1.73 m2per year) states. The transition rate between states and the impact of clinical parameters were estimated by a Markov model.ResultsThe analysis was based on 494 SLE patients. At a mean follow-up of 8.8 years, 347 (70.2%), 107 (21.7%), 33 (6.7%), and 7 (1.4%) patients had zero, one, two, and three state transitions, respectively. In patients with no transition, 37 (10.7%), 308 (88.8%), and 2 (0.6%) were in declining, stable, and increasing state, respectively. In patients with one transition, 43 (40.2%) changed from declining to stable state while 29 (27.1%) changed from stable to declining state. When patients were in a non-declining GFR state, those who were younger and African Americans were more likely to transition to a declining GFR state. In adjusted analyses, high blood pressure, C4 and low hematocrit were associated with change from non-declining to declining state. High urine protein-to-creatinine ratio also tended to be associated with change from non-declining to declining state. African American patients were less likely to move from declining to non-declining state. Use of prednisone was associated with change from declining to non-declining state.ConclusionsPatients with high blood pressure, low complement C4, low haematocrit, and high urine protein-to-creatinine ratio are more likely to have a declining eGFR trajectory, while the use of prednisone stabilizes the declining eGFR trajectory. |
| Databáze: | OpenAIRE |
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