Four trajectories of 24-hour urine protein levels in real-world lupus nephritis cohorts
Objectives A 24-hour urine protein (24hUP) is a key measurement in the management of lupus nephritis (LN); however, trajectories of 24hUP in LN is poorly defined.Methods Two LN cohorts that underwent renal biopsies at Renji Hospital were included. Patients received standard of care in a real-world s...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-04-01
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| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/9/2/e002930.full |
| _version_ | 1797772327490945024 |
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| author | Ting Li Fangfang Sun Xiaodong Wang Shuang Ye Nan Shen Jie Chen Huihua Ding Danting Zhang |
| author_facet | Ting Li Fangfang Sun Xiaodong Wang Shuang Ye Nan Shen Jie Chen Huihua Ding Danting Zhang |
| author_sort | Ting Li |
| collection | DOAJ |
| description | Objectives A 24-hour urine protein (24hUP) is a key measurement in the management of lupus nephritis (LN); however, trajectories of 24hUP in LN is poorly defined.Methods Two LN cohorts that underwent renal biopsies at Renji Hospital were included. Patients received standard of care in a real-world setting and 24hUP data were collected over time. Trajectory patterns of 24hUP were determined using the latent class mixed modelling (LCMM). Baseline characters were compared among trajectories and multinomial logistic regression was used to determine independent risk factors. Optimal combinations of variables were identified for model construction and user-friendly nomograms were developed.Results The derivation cohort composed of 194 patients with LN with 1479 study visits and a median follow-up of 17.5 (12.2–21.7) months. Four trajectories of 24hUP were identified, that is, Rapid Responders, Good Responders, Suboptimal Responders and Non-Responders, with the KDIGO renal complete remission rates (time to complete remission, months) of 84.2% (4.19), 79.6% (7.94), 40.4% (not applicable) and 9.8% (not applicable), respectively (p<0.001). The ‘Rapid Responders’ distinguish itself from other trajectories and a nomogram, composed of age, systemic lupus erythematosus duration, albumin and 24hUP yielded C-indices >0.85. Another nomogram to predict ‘Good Responders’ yielded C-indices of 0.73~0.78, which composed of gender, new-onset LN, glomerulosclerosis and partial remission within 6 months. When applied to the validation cohort with 117 patients and 500 study visits, nomograms effectively sorted out ‘Rapid Responders’ and ‘Good Responders’.Conclusion Four trajectories of LN shed some light to guide the management of LN and further clinical trials design. |
| first_indexed | 2024-03-12T21:50:29Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2056-5933 |
| language | English |
| last_indexed | 2024-03-12T21:50:29Z |
| publishDate | 2023-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | RMD Open |
| spelling | doaj.art-b79fcfacc0344edeba50419955b3551c2023-07-26T04:35:06ZengBMJ Publishing GroupRMD Open2056-59332023-04-019210.1136/rmdopen-2022-002930Four trajectories of 24-hour urine protein levels in real-world lupus nephritis cohortsTing Li0Fangfang Sun1Xiaodong Wang2Shuang Ye3Nan Shen4Jie Chen5Huihua Ding6Danting Zhang7Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Rheumatology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, Huangpu, ChinaDepartment of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, ChinaRheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, ChinaDepartment of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Rheumatology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, Huangpu, ChinaObjectives A 24-hour urine protein (24hUP) is a key measurement in the management of lupus nephritis (LN); however, trajectories of 24hUP in LN is poorly defined.Methods Two LN cohorts that underwent renal biopsies at Renji Hospital were included. Patients received standard of care in a real-world setting and 24hUP data were collected over time. Trajectory patterns of 24hUP were determined using the latent class mixed modelling (LCMM). Baseline characters were compared among trajectories and multinomial logistic regression was used to determine independent risk factors. Optimal combinations of variables were identified for model construction and user-friendly nomograms were developed.Results The derivation cohort composed of 194 patients with LN with 1479 study visits and a median follow-up of 17.5 (12.2–21.7) months. Four trajectories of 24hUP were identified, that is, Rapid Responders, Good Responders, Suboptimal Responders and Non-Responders, with the KDIGO renal complete remission rates (time to complete remission, months) of 84.2% (4.19), 79.6% (7.94), 40.4% (not applicable) and 9.8% (not applicable), respectively (p<0.001). The ‘Rapid Responders’ distinguish itself from other trajectories and a nomogram, composed of age, systemic lupus erythematosus duration, albumin and 24hUP yielded C-indices >0.85. Another nomogram to predict ‘Good Responders’ yielded C-indices of 0.73~0.78, which composed of gender, new-onset LN, glomerulosclerosis and partial remission within 6 months. When applied to the validation cohort with 117 patients and 500 study visits, nomograms effectively sorted out ‘Rapid Responders’ and ‘Good Responders’.Conclusion Four trajectories of LN shed some light to guide the management of LN and further clinical trials design.https://rmdopen.bmj.com/content/9/2/e002930.full |
| spellingShingle | Ting Li Fangfang Sun Xiaodong Wang Shuang Ye Nan Shen Jie Chen Huihua Ding Danting Zhang Four trajectories of 24-hour urine protein levels in real-world lupus nephritis cohorts RMD Open |
| title | Four trajectories of 24-hour urine protein levels in real-world lupus nephritis cohorts |
| title_full | Four trajectories of 24-hour urine protein levels in real-world lupus nephritis cohorts |
| title_fullStr | Four trajectories of 24-hour urine protein levels in real-world lupus nephritis cohorts |
| title_full_unstemmed | Four trajectories of 24-hour urine protein levels in real-world lupus nephritis cohorts |
| title_short | Four trajectories of 24-hour urine protein levels in real-world lupus nephritis cohorts |
| title_sort | four trajectories of 24 hour urine protein levels in real world lupus nephritis cohorts |
| url | https://rmdopen.bmj.com/content/9/2/e002930.full |
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