IgA Nephropathy: Quantifying Remission Duration on Clinical Outcome
Bibliographic record
Abstract
Background: A relative reduction in proteinuria has been proposed as a surrogate outcome for therapeutic trials in IgA nephropathy (IgAN). We sought to quantify the association between duration of proteinuria remission and the risk of disease progression in IgAN. Methods: In this retrospective international cohort of adult patients with biopsyproven IgAN, we defined remission based on: (i) a ≥25% reduction in proteinuria from the peak value after biopsy; (ii) an absolute reduction in proteinuria to <1g/day; (iii) peak proteinuria prior to remission ≥1g/day. The total duration of first remission was treated as a time-varying exposure using longitudinal proteinuria measurements. Time-dependent Cox proportional hazards models were used to quantify the association between duration of remission and the primary outcome (ESKD or 50% reduction in eGFR). Results: Of 1864 patients who entered a first remission, 274 (14.7%) experienced the outcome during median follow-up of 3.9 years. The relationship between duration of proteinuria remission and the primary outcome was non-linear (Figure). Each 3 months in sustained remission up to 51 months was associated with an additional 9% reduction in the risk of disease progression (HR 0.91, 95% CI 0.89-0.93). Each additional 3 months in remission beyond 51 months was associated with a non-significant risk reduction (HR 0.99, 95% CI 0.96-1.03). Results were robust to multivariable adjustment and consistent across subgroups including immunosuppression exposure. Conclusions: We observed a non-linear dose-response relationship between the duration of proteinuria remission and the risk of disease progression in IgAN. When considering proteinuria as a surrogate outcome, our findings illustrate the need to consider the duration of remission in addition to the magnitude of proteinuria reduction when evaluating the anticipated impact on long-term clinical endpoints.
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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 | 0.018 | 0.026 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
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".