Systemic lupus international collaborating clinics renal activity/response exercise: Comparison of agreement in rating renal response

Michelle Petri, Nuntana Kasitanon, Sukminder Singh, Kimberly Link, Laurence Magder, Sang Cheol Bae, John G. Hanly, Ola Nived, Gunnar Sturfelt, Ronald Van Vollenhoven, Daniel J. Wallace, Graciela S. Alarcón, Dwomoa Adu, Carmen Avila-Casado, Sasha R. Bernatsky, Ian N. Bruce, Ann E. Clarke, Gabriel Contreras, Derek M. Fine, Dafna D. GladmanCaroline Gordon, Kenneth C. Kalunian, Michael P. Madaio, Brad H. Rovin, Jorge Sanchez-Guerrero, Kristjan Steinsson, Cynthia Aranow, James E. Balow, Jill P. Buyon, Ellen M. Ginzler, Munther A. Khamashta, Murray B. Urowitz, Mary Anne Dooley, Joan T. Merrill, Rosalind Ramsey-Goldman, Josef Font, James Tumlin, Thomas Stoll, Asad Zoma

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objective. To assess the degree to which physicians agree with each other and with ratings obtained with 3 existing responder indices, in rating the response to treatment of lupus nephritis. Methods. Lupus nephritis patient medical records from 125 pairs of visits (6 months apart) were used to create renal response scenarios. Seven nephrologists and 22 rheumatologists rated each scenario as demonstrating complete response, partial response, same, or worsening. The plurality (most frequent) rating of renal response by the physicians was compared with the calculated score from the renal component of the British Isles Lupus Assessment Group (BILAG) index (original and updated [2004] version) and of the Responder Index for Lupus Erythematosus (RIFLE). The degree of agreement among the physicians was assessed by calculating intraclass correlation coefficients (ICCs). The degree of agreement between the plurality physician rating and ratings obtained with the established response indices was assessed using the kappa statistic. Results. The ICC among all physicians was 0.64 (0.62 for nephrologists and 0.67 for rheumatologists). The chance-adjusted measure of agreement (kappa coefficient) between the plurality physician rating and the calculated score obtained using established indexes was 0.50 (95% confidence interval [95% CI] 0.38-0.61) for the RIFLE, 0.14 (95% CI 0.03-0.25) for the original BILAG, and 0.23 (95% CI 0.21-0.44) for the BILAG 2004. Conclusion. These findings indicate that rheumatologists as a group and nephrologists as a group have equal agreement in their rating of renal response. There was moderate agreement between plurality physician ratings and ratings obtained using the renal component of the RIFLE. Ratings of response using an index based on the original BILAG did not have good agreement with the plurality physician rating.

Original languageEnglish (US)
Pages (from-to)1789-1795
Number of pages7
JournalArthritis and Rheumatism
Volume58
Issue number6
DOIs
StatePublished - Jun 1 2008

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Ambulatory Care Facilities
Exercise
Physicians
Kidney
Lupus Nephritis
Confidence Intervals
Medical Records
Rheumatologists
Nephrologists

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology
  • Pharmacology (medical)

Cite this

Systemic lupus international collaborating clinics renal activity/response exercise : Comparison of agreement in rating renal response. / Petri, Michelle; Kasitanon, Nuntana; Singh, Sukminder; Link, Kimberly; Magder, Laurence; Bae, Sang Cheol; Hanly, John G.; Nived, Ola; Sturfelt, Gunnar; Van Vollenhoven, Ronald; Wallace, Daniel J.; Alarcón, Graciela S.; Adu, Dwomoa; Avila-Casado, Carmen; Bernatsky, Sasha R.; Bruce, Ian N.; Clarke, Ann E.; Contreras, Gabriel; Fine, Derek M.; Gladman, Dafna D.; Gordon, Caroline; Kalunian, Kenneth C.; Madaio, Michael P.; Rovin, Brad H.; Sanchez-Guerrero, Jorge; Steinsson, Kristjan; Aranow, Cynthia; Balow, James E.; Buyon, Jill P.; Ginzler, Ellen M.; Khamashta, Munther A.; Urowitz, Murray B.; Dooley, Mary Anne; Merrill, Joan T.; Ramsey-Goldman, Rosalind; Font, Josef; Tumlin, James; Stoll, Thomas; Zoma, Asad.

In: Arthritis and Rheumatism, Vol. 58, No. 6, 01.06.2008, p. 1789-1795.

Research output: Contribution to journalArticle

Petri, M, Kasitanon, N, Singh, S, Link, K, Magder, L, Bae, SC, Hanly, JG, Nived, O, Sturfelt, G, Van Vollenhoven, R, Wallace, DJ, Alarcón, GS, Adu, D, Avila-Casado, C, Bernatsky, SR, Bruce, IN, Clarke, AE, Contreras, G, Fine, DM, Gladman, DD, Gordon, C, Kalunian, KC, Madaio, MP, Rovin, BH, Sanchez-Guerrero, J, Steinsson, K, Aranow, C, Balow, JE, Buyon, JP, Ginzler, EM, Khamashta, MA, Urowitz, MB, Dooley, MA, Merrill, JT, Ramsey-Goldman, R, Font, J, Tumlin, J, Stoll, T & Zoma, A 2008, 'Systemic lupus international collaborating clinics renal activity/response exercise: Comparison of agreement in rating renal response', Arthritis and Rheumatism, vol. 58, no. 6, pp. 1789-1795. https://doi.org/10.1002/art.23802
Petri, Michelle ; Kasitanon, Nuntana ; Singh, Sukminder ; Link, Kimberly ; Magder, Laurence ; Bae, Sang Cheol ; Hanly, John G. ; Nived, Ola ; Sturfelt, Gunnar ; Van Vollenhoven, Ronald ; Wallace, Daniel J. ; Alarcón, Graciela S. ; Adu, Dwomoa ; Avila-Casado, Carmen ; Bernatsky, Sasha R. ; Bruce, Ian N. ; Clarke, Ann E. ; Contreras, Gabriel ; Fine, Derek M. ; Gladman, Dafna D. ; Gordon, Caroline ; Kalunian, Kenneth C. ; Madaio, Michael P. ; Rovin, Brad H. ; Sanchez-Guerrero, Jorge ; Steinsson, Kristjan ; Aranow, Cynthia ; Balow, James E. ; Buyon, Jill P. ; Ginzler, Ellen M. ; Khamashta, Munther A. ; Urowitz, Murray B. ; Dooley, Mary Anne ; Merrill, Joan T. ; Ramsey-Goldman, Rosalind ; Font, Josef ; Tumlin, James ; Stoll, Thomas ; Zoma, Asad. / Systemic lupus international collaborating clinics renal activity/response exercise : Comparison of agreement in rating renal response. In: Arthritis and Rheumatism. 2008 ; Vol. 58, No. 6. pp. 1789-1795.
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title = "Systemic lupus international collaborating clinics renal activity/response exercise: Comparison of agreement in rating renal response",
abstract = "Objective. To assess the degree to which physicians agree with each other and with ratings obtained with 3 existing responder indices, in rating the response to treatment of lupus nephritis. Methods. Lupus nephritis patient medical records from 125 pairs of visits (6 months apart) were used to create renal response scenarios. Seven nephrologists and 22 rheumatologists rated each scenario as demonstrating complete response, partial response, same, or worsening. The plurality (most frequent) rating of renal response by the physicians was compared with the calculated score from the renal component of the British Isles Lupus Assessment Group (BILAG) index (original and updated [2004] version) and of the Responder Index for Lupus Erythematosus (RIFLE). The degree of agreement among the physicians was assessed by calculating intraclass correlation coefficients (ICCs). The degree of agreement between the plurality physician rating and ratings obtained with the established response indices was assessed using the kappa statistic. Results. The ICC among all physicians was 0.64 (0.62 for nephrologists and 0.67 for rheumatologists). The chance-adjusted measure of agreement (kappa coefficient) between the plurality physician rating and the calculated score obtained using established indexes was 0.50 (95{\%} confidence interval [95{\%} CI] 0.38-0.61) for the RIFLE, 0.14 (95{\%} CI 0.03-0.25) for the original BILAG, and 0.23 (95{\%} CI 0.21-0.44) for the BILAG 2004. Conclusion. These findings indicate that rheumatologists as a group and nephrologists as a group have equal agreement in their rating of renal response. There was moderate agreement between plurality physician ratings and ratings obtained using the renal component of the RIFLE. Ratings of response using an index based on the original BILAG did not have good agreement with the plurality physician rating.",
author = "Michelle Petri and Nuntana Kasitanon and Sukminder Singh and Kimberly Link and Laurence Magder and Bae, {Sang Cheol} and Hanly, {John G.} and Ola Nived and Gunnar Sturfelt and {Van Vollenhoven}, Ronald and Wallace, {Daniel J.} and Alarc{\'o}n, {Graciela S.} and Dwomoa Adu and Carmen Avila-Casado and Bernatsky, {Sasha R.} and Bruce, {Ian N.} and Clarke, {Ann E.} and Gabriel Contreras and Fine, {Derek M.} and Gladman, {Dafna D.} and Caroline Gordon and Kalunian, {Kenneth C.} and Madaio, {Michael P.} and Rovin, {Brad H.} and Jorge Sanchez-Guerrero and Kristjan Steinsson and Cynthia Aranow and Balow, {James E.} and Buyon, {Jill P.} and Ginzler, {Ellen M.} and Khamashta, {Munther A.} and Urowitz, {Murray B.} and Dooley, {Mary Anne} and Merrill, {Joan T.} and Rosalind Ramsey-Goldman and Josef Font and James Tumlin and Thomas Stoll and Asad Zoma",
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TY - JOUR

T1 - Systemic lupus international collaborating clinics renal activity/response exercise

T2 - Comparison of agreement in rating renal response

AU - Petri, Michelle

AU - Kasitanon, Nuntana

AU - Singh, Sukminder

AU - Link, Kimberly

AU - Magder, Laurence

AU - Bae, Sang Cheol

AU - Hanly, John G.

AU - Nived, Ola

AU - Sturfelt, Gunnar

AU - Van Vollenhoven, Ronald

AU - Wallace, Daniel J.

AU - Alarcón, Graciela S.

AU - Adu, Dwomoa

AU - Avila-Casado, Carmen

AU - Bernatsky, Sasha R.

AU - Bruce, Ian N.

AU - Clarke, Ann E.

AU - Contreras, Gabriel

AU - Fine, Derek M.

AU - Gladman, Dafna D.

AU - Gordon, Caroline

AU - Kalunian, Kenneth C.

AU - Madaio, Michael P.

AU - Rovin, Brad H.

AU - Sanchez-Guerrero, Jorge

AU - Steinsson, Kristjan

AU - Aranow, Cynthia

AU - Balow, James E.

AU - Buyon, Jill P.

AU - Ginzler, Ellen M.

AU - Khamashta, Munther A.

AU - Urowitz, Murray B.

AU - Dooley, Mary Anne

AU - Merrill, Joan T.

AU - Ramsey-Goldman, Rosalind

AU - Font, Josef

AU - Tumlin, James

AU - Stoll, Thomas

AU - Zoma, Asad

PY - 2008/6/1

Y1 - 2008/6/1

N2 - Objective. To assess the degree to which physicians agree with each other and with ratings obtained with 3 existing responder indices, in rating the response to treatment of lupus nephritis. Methods. Lupus nephritis patient medical records from 125 pairs of visits (6 months apart) were used to create renal response scenarios. Seven nephrologists and 22 rheumatologists rated each scenario as demonstrating complete response, partial response, same, or worsening. The plurality (most frequent) rating of renal response by the physicians was compared with the calculated score from the renal component of the British Isles Lupus Assessment Group (BILAG) index (original and updated [2004] version) and of the Responder Index for Lupus Erythematosus (RIFLE). The degree of agreement among the physicians was assessed by calculating intraclass correlation coefficients (ICCs). The degree of agreement between the plurality physician rating and ratings obtained with the established response indices was assessed using the kappa statistic. Results. The ICC among all physicians was 0.64 (0.62 for nephrologists and 0.67 for rheumatologists). The chance-adjusted measure of agreement (kappa coefficient) between the plurality physician rating and the calculated score obtained using established indexes was 0.50 (95% confidence interval [95% CI] 0.38-0.61) for the RIFLE, 0.14 (95% CI 0.03-0.25) for the original BILAG, and 0.23 (95% CI 0.21-0.44) for the BILAG 2004. Conclusion. These findings indicate that rheumatologists as a group and nephrologists as a group have equal agreement in their rating of renal response. There was moderate agreement between plurality physician ratings and ratings obtained using the renal component of the RIFLE. Ratings of response using an index based on the original BILAG did not have good agreement with the plurality physician rating.

AB - Objective. To assess the degree to which physicians agree with each other and with ratings obtained with 3 existing responder indices, in rating the response to treatment of lupus nephritis. Methods. Lupus nephritis patient medical records from 125 pairs of visits (6 months apart) were used to create renal response scenarios. Seven nephrologists and 22 rheumatologists rated each scenario as demonstrating complete response, partial response, same, or worsening. The plurality (most frequent) rating of renal response by the physicians was compared with the calculated score from the renal component of the British Isles Lupus Assessment Group (BILAG) index (original and updated [2004] version) and of the Responder Index for Lupus Erythematosus (RIFLE). The degree of agreement among the physicians was assessed by calculating intraclass correlation coefficients (ICCs). The degree of agreement between the plurality physician rating and ratings obtained with the established response indices was assessed using the kappa statistic. Results. The ICC among all physicians was 0.64 (0.62 for nephrologists and 0.67 for rheumatologists). The chance-adjusted measure of agreement (kappa coefficient) between the plurality physician rating and the calculated score obtained using established indexes was 0.50 (95% confidence interval [95% CI] 0.38-0.61) for the RIFLE, 0.14 (95% CI 0.03-0.25) for the original BILAG, and 0.23 (95% CI 0.21-0.44) for the BILAG 2004. Conclusion. These findings indicate that rheumatologists as a group and nephrologists as a group have equal agreement in their rating of renal response. There was moderate agreement between plurality physician ratings and ratings obtained using the renal component of the RIFLE. Ratings of response using an index based on the original BILAG did not have good agreement with the plurality physician rating.

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