Longitudinal Trajectories of Kidney Function in Patients with Severe ANCA-Associated Vasculitis
Bibliographic record
Abstract
Key Points We identified four kidney function trajectories in ANCA-associated vasculitis associated with varied risk of ESKD and CKD. Male sex, myeloperoxidase-ANCA specificity, baseline hypertension, and lower baseline eGFR were associated with adverse kidney function trajectory. Differences in baseline characteristics identify potential targets for personalized care. Background ANCA-associated vasculitis (AAV) causes GN culminating in a spectrum of CKD and ESKD. Kidney function trajectories with differing CKD risk were reported in a single-center study. We sought to confirm these findings in the Plasma Exchange and Glucocorticoids in Severe AAV trial cohort. Methods This cohort study included patients from Plasma Exchange and Glucocorticoids in Severe AAV with a baseline and one or more eGFR measurements over 36 months to identify groups with similar longitudinal change in kidney function using group-based trajectory analysis. We evaluated factors associated with group membership using multivariable-adjusted multinomial logistic regression. Results We identified four trajectory groups among 663 patients: early ESKD (113, 17%), stable impairment (400, 60%), impaired with improvement (131, 20%), and marked improvement (19, 3%). ESKD occurred in 137 patients (21%): 113 (100%) in the early ESKD, 23 (6%) in the stable impairment, and 1 (1%) in the impaired with improvement groups. Older baseline age (adjusted odds ratio [aOR], 0.97 per 1 year; 95% confidence interval [CI], 0.95 to 0.99), female sex (aOR, 0.54; 95% CI, 0.31 to 0.94), and baseline eGFR (aOR, 0.93 per 1 ml/min per 1.73 m 2 increase; 95% CI, 0.88 to 0.99) were associated with lower odds of early ESKD versus impaired with improvement membership. Myeloperoxidase-ANCA+ (aOR, 2.35; 95% CI, 1.33 to 4.16) and hypertension (aOR, 2.50; 95% CI, 1.33 to 4.69) were associated with higher odds of early ESKD membership. Conclusions We identified four kidney function trajectories in AAV associated with varied risk of ESKD and CKD; male sex, myeloperoxidase-ANCA specificity, baseline hypertension, and lower baseline eGFR were associated with adverse kidney function trajectory. Differences in baseline characteristics identify potential targets for personalized care.
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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 | 0.005 |
| 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 | 0.001 |
| Open science | 0.000 | 0.001 |
| 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".