{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,8]],"date-time":"2026-11-08T06:26:01Z","timestamp":1794119161814,"version":"4.8.0"},"reference-count":41,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2016,7,27]],"date-time":"2016-07-27T00:00:00Z","timestamp":1469577600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arthritis & Rheumatology"],"published-print":{"date-parts":[[2016,8]]},"abstract":"Objective<\/jats:title>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.<\/jats:p><\/jats:sec>Methods<\/jats:title>Patients in the Systemic Lupus International Collaborating Clinics inception cohort were classified annually into estimated GFR state 1 (>60 ml\/minute), state 2 (30\u201360 ml\/minute), or state 3 (<30 ml\/minute) and estimated proteinuria state 1 (<0.25 gm\/day), state 2 (0.25\u20133.0 gm\/day), or state 3 (>3.0 gm\/day), or end\u2010stage renal disease (ESRD) or death. Using multistate modeling, relative transition rates between states indicated improvement and deterioration.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 1,826 lupus patients, 700 (38.3%) developed LN. During a mean\u2009\u00b1\u2009SD follow\u2010up of 5.2\u2009\u00b1\u20093.5 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.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>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.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.39674","type":"journal-article","created":{"date-parts":[[2016,3,19]],"date-time":"2016-03-19T03:25:21Z","timestamp":1458357921000},"page":"1932-1944","source":"Crossref","is-referenced-by-count":43,"title":["A Longitudinal Analysis of Outcomes of Lupus Nephritis in an International Inception Cohort Using a Multistate Model Approach"],"prefix":"10.1002","volume":"68","author":[{"given":"John G.","family":"Hanly","sequence":"first","affiliation":[{"name":"Queen Elizabeth II Health Sciences Centre and Dalhousie University Halifax Nova Scotia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Su","sequence":"additional","affiliation":[{"name":"Institute of Public Health and University of Cambridge, University Forvie Site Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murray B.","family":"Urowitz","sequence":"additional","affiliation":[{"name":"Toronto Western Hospital and University of Toronto Toronto, Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juanita","family":"Romero\u2010Diaz","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Mexico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Gordon","sequence":"additional","affiliation":[{"name":"University of Birmingham, College of Medical and Dental Sciences Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang\u2010Cheol","family":"Bae","sequence":"additional","affiliation":[{"name":"Hanyang University Hospital for Rheumatic Diseases Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasha","family":"Bernatsky","sequence":"additional","affiliation":[{"name":"McGill University Health Centre Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann E.","family":"Clarke","sequence":"additional","affiliation":[{"name":"University of Calgary Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"Wallace","sequence":"additional","affiliation":[{"name":"Cedars\u2010Sinai Medical Center and University of California, Los Angeles, David Geffen School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan T.","family":"Merrill","sequence":"additional","affiliation":[{"name":"Oklahoma Medical Research Foundation Oklahoma City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Isenberg","sequence":"additional","affiliation":[{"name":"University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anisur","family":"Rahman","sequence":"additional","affiliation":[{"name":"University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen M.","family":"Ginzler","sequence":"additional","affiliation":[{"name":"State University of New York Downstate Medical Center Brooklyn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Petri","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian N.","family":"Bruce","sequence":"additional","affiliation":[{"name":"Arthritis Research UK Epidemiology Unit, Manchester Academic Health Sciences Centre, University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, and Manchester Academic Health Science Centre Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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