THE IMPACT OF CUMULATIVE ANEMIA EXPOSURE ON THE RISK OF RENAL DAMAGE IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS
Bibliographic record
Abstract
PV241 / #806 Poster Topic: AS23 - SLE-Diagnosis, Manifestations, & Outcomes Background/Purpose Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that can involve multiple organ systems, including the kidneys, blood, and skin. Lupus Nephritis (LN) is the most severe complication of SLE, with treatment objectives aimed at preventing chronic kidney disease (CKD) and End-Stage Renal Disease (ESRD), optimizing quality of life, and improving survival. Anemia is the most common hematologic complication in SLE and is closely associated with disease activity, multiorgan dysfunction, and particularly the progression of renal damage. However, mild to moderate anemia has long been neglected in the diagnosis and management of SLE, and there is limited research on the impact of cumulative anemia exposure on renal damage in SLE patients. This study aims to utilize 12 years of natural follow-up data from SLE patients at Xiangya Hospital to conduct a real-world retrospective cohort study investigating the impact of cumulative anemia exposure on the risk of renal damage in SLE patients. Methods A study cohort was established using data from SLE patients with confirmed diagnoses who were treated at Xiangya Hospital between January 2010 and June 2022. Longitudinal hemoglobin (Hb) concentration data were used to construct hemoglobin concentration-time curves, and variables such as average hemoglobin concentration, proportion of anemia duration, and cumulative anemia exposure were defined. New-onset CKD and ESRD were selected as outcome indicators for survival analysis. Multivariable Cox regression models were employed to explore the effects of these anemia-related variables on the development of CKD and ESRD in SLE patients, with adjustments made for known renal prognostic risk factors. Subgroup analyses were conducted for LN patients. Sensitivity analyses examined the relationship between the proportion of mild, moderate, and severe anemia duration and the risks of CKD and ESRD. Restricted cubic spline Cox regression models were used to investigate the dose-response relationships between cumulative anemia exposure variables and the risks of CKD and ESRD. Results A total of 2,361 SLE patients were included in the study, with 88.1% being female. The median age was 33 years, and the median follow-up time was 57.5 months. Among these patients, 52% had LN, and the baseline mean estimated glomerular filtration rate (eGFR) was 98.5 ± 27.8 mL/min/1.73 m². Cox analysis revealed that an average hemoglobin concentration below the anemia threshold increased the risk of CKD by 6.18-fold and ESRD by 14.14-fold in SLE patients. Cumulative anemia exposure greater than 0 was associated with a 2.24-fold increased risk of CKD and a 9.46-fold increased risk of ESRD. Among LN patients, the associations between average hemoglobin concentration, cumulative anemia exposure, and the risks of CKD and ESRD were more pronounced. Sensitivity analyses showed that a proportion of moderate anemia duration greater than 0 significantly increased the risks of CKD and ESRD in both SLE and LN patients. Restricted cubic spline analysis indicated that the risks of CKD and ESRD increased with longer anemia duration and greater cumulative anemia exposure. Conclusions Prolonged anemia exposure is strongly associated with renal damage. Reducing the duration of moderate anemia and cumulative anemia exposure may serve as effective targets for improving renal outcomes in SLE patients.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 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) | 0.001 | 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".