ABSTRACT
Ambiguities remain regarding the role of clinicopathological characteristics in the early prediction of the prognosis of lupus nephritis (LN). Systemic lupus erythematosus (SLE) patients who completed routine follow-up were identified and retrospectively reviewed for eligible cases. Poor prognosis was defined as all-cause mortality or a persistent decrease of eGFR greater than half the baseline level or progression to end-stage renal disease (ESRD). An optimal Cox regression model was constructed for the early prediction of a poor prognosis for LN. Among the 2163 SLE patients, 376 eligible LN cases were enrolled in the study, with a median follow-up time of 55 [27.0, 87.0] months. The male-to-female ratio was 1:7.2, and 37 patients (9.8%) progressed to the composite endpoint. The ISN/RPS class was significantly associated with proteinuria levels (P-value < 0.001), and class IV/IV + V patients, but not class V patients, had the most severe proteinuria. Our optimal multivariate Cox regression model indicated that sex, ISN/RPS class, tubular atrophy/interstitial fibrosis, serum albumin, tertiles of proteinuria, and their interaction were independently associated with a poor prognosis. ROC analysis and external validation demonstrated that our model was efficient and robust for distinguishing LN patients with a poor prognosis. Our study constructed a robust and early predictive model for convenience in clinical practice to identify poor prognosis in LN patients. We found a significant interaction effect between proteinuria and serum albumin for the prediction of poor prognosis. LN patients with low-level proteinuria and hypoalbuminemia exhibit an increased hazard of progression to poor outcomes.
Subject(s)
Kidney Failure, Chronic/epidemiology , Kidney Tubules/pathology , Lupus Nephritis/mortality , Proteinuria/epidemiology , Adult , Biopsy , Disease Progression , Female , Fibrosis , Follow-Up Studies , Glomerular Filtration Rate , Humans , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/immunology , Kidney Failure, Chronic/pathology , Lupus Nephritis/immunology , Lupus Nephritis/pathology , Male , Prognosis , Proteinuria/diagnosis , Proteinuria/immunology , Proteinuria/pathology , Retrospective Studies , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Serum Albumin, Human/analysis , Severity of Illness IndexABSTRACT
BACKGROUND: To explore the effects of different calcium concentrations of peritoneal dialysis solution (PDS) on continuous ambulatory peritoneal dialysis (CAPD) and expression of vimentin (VIM), fibroblast-specific protein (FSP1), and E-cadherin. MATERIALS AND METHODS: This was a pilot study (#ChiCTR1900021387) conducted from January 2017 to December 2019 at the Hospital. The patients were randomized to undergo CAPD using PDS with a calcium concentration of 1.25 mmol/L (low concentration group) or 1.75 mmol/L (high concentration group). Changes in biochemistry before dialysis and at 6 and 12 months were analyzed. RESULTS: There were 50 and 52 participants in the low and high calcium groups. The blood biochemical indexes were all different between the two groups (all Ptime < .05, Pgroup < .05, Pinteraction < .05), but they remained within their normal ranges. VIM and FSP1 increased over 12 months (Ptime < .05); VIM and FSP1 levels in the high concentration group were higher than in the low concentration group (Pgroup < .05, Pinteraction < .05), while E-cadherin showed the inverse association (Ptime < .001, Pgroup < .001, Pinteraction < .001). There was no difference in complications (P = .973). CONCLUSION: The calcium concentration in PDS might be an important factor affecting the progression of peritoneal fibrosis.
