LP-207 Impact of time to remission, flares and time on immunosuppressives on the estimated glomerular filtration rate in lupus nephritis
Bibliographic record
Abstract
Background Time to complete remission, subsequent flares and time on immunosuppressives after remission are major determinants of the progression to advanced chronic kidney disease (CKD) in lupus nephritis (LN). However, the impact of these factors on the rate of glomerular filtration rate (GFR) deterioration is not known. Our objective was to determine their impact on the estimated GFR in LN. Methods Patients with LN based on biopsy or abnormal proteinuria (>0.5g/day) for two consecutive visits were retrieved from the Toronto Lupus Clinic database. Individuals with advanced CKD at baseline (eGFR&x2266;29ml/min/1.73m2) were excluded. All patients were followed for ≥ 5 years. The primary outcome was the annual eGFR decrease (slope). Remission: proteinuria<0.5g/24h, inactive urinary sediment, serum creatinine (SCR) &x2266;120% of baseline. Flare: abnormal proteinuria (>0.5g/day) or SCR increase from normal to abnormal or >120% of baseline after remission. Results Of 418 eligible patients, 209 (50%) achieved remission within the first year, 102 (24.4%) within the 2nd/3rd years, 70 (16.7%) after 3 years and 37 (8.9%) never achieved remission. Regarding flares, 82 patients (19.6%) never flared, 75 (18%) had one flare and 261 (62.4%) had ≥2 flares. The total number of flares was 1159; 203 (17.5%) were characterized by an eGFR decrease of ≥10ml/min/1.73m2. The trajectory and annual slope of eGFR according to time to remission and number of flares is shown in the Figure. Conclusions Complete remission after 3 years or no remission is associated with a significant eGFR decrease, while remission during the 2nd/3rd year from LN diagnosis is not associated with any significant eGFR decrease over time. Patients with one flare did not have any significant impact on their renal function over time. Patients with ≥2 flares had a significant eGFR decrease over 20 years, after adjustment for other covariates. Time on immunosuppressives after complete remission is protective against eGFR decline.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".