Predicting 5-Year Risk of RRT in Stage 3 or 4 CKD: Development and External Validation

Clinical journal of the American Society of Nephrology: CJASN

David H. Smith¹  Robert W. Platt²  Emily B. Schroeder³  Amanda F. Petrik⁴  Micah L. Thorp⁶ 

[1] and..‖Department of Nephrology, Kaiser Permanente Colorado, Denver, Colorado;*Institute for Health Research and..;*Institute for Health Research and..†Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado;§Department of Nephrology, Kaiser Permanente Northwest, Portland, Oregon;¶Department of Epidemiology, Biostatistics and Occupational Health, McGill University Health Centre Research Institute, Montreal, Quebec, Canada..‡Center for Health Research and..;‡Center for Health Research and..

关键词: chronic kidney disease;    renal failure;    risk assessment;    disease progression;    prognosis;    clinical prediction rule;    albuminuria;    Antihypertensive Agents;    blood pressure;    Calibration;    Colorado;    diabetes mellitus;    Fistula;    glomerular filtration rate;    Hemoglobins;    Humans;    nephrology;    Primary Health Care;    proteinuria;    Referral and Consultation;    Renal Insufficiency;    renal insufficiency, chronic;    renal replacement therapy;    retrospective studies;   

DOI  :  10.2215/CJN.01290216

学科分类：泌尿医学

来源: American Society of Nephrology

【 摘 要 】

Background and objectives Only a minority of patients with CKD progress to renal failure. Despite the potential benefits of risk stratification in the CKD population, risk prediction models are not routinely used. Our objective was to develop and externally validate a clinically useful and pragmatic prediction model for the 5-year risk of progression to RRT in stage 3 or 4 CKD.Design, setting, participants, & measurements We used a retrospective cohort design. The development cohort consisted of 22,460 Kaiser Permanente Northwest members with stage 3 or 4 CKD (baseline 2002–2008). The validation cohort consisted of 16,553 Kaiser Permanente Colorado members with stage 3–4 CKD (baseline 2006–2008). The final model included eight predictors: age, sex, eGFR, hemoglobin, proteinuria/albuminuria, systolic BP, antihypertensive medication use, and diabetes and its complications.Results In the Northwest and Colorado cohorts, there were 737 and 360 events, and observed 5-year Kaplan–Meier risks of 4.72% (95% confidence interval [95% CI], 4.38 to 5.06) and 2.57% (95% CI, 2.30 to 2.83), respectively. Our prediction model performed extremely well in the development cohort, with a c-statistic of 0.96, an R2 of 79.7%, and good calibration. We had similarly good performance in the external validation cohort, with a c-statistic of 0.95, R2 of 81.2%, and good calibration. In the external validation cohort, the observed risk was slightly lower than the predicted risk in the highest-risk quintile. Using the top quintile of predicted risk as a cutpoint gave a sensitivity of 92.2%.Conclusions We developed a pragmatic prediction model and risk score for predicting the 5-year RRT risk in stage 3 and 4 CKD. This model uses variables that are typically available in routine primary care settings, and can be used to help guide important decisions such as timing of referral to nephrology and fistula placement.

【 授权许可】

CC BY