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Simple model predicts progression of kidney disease among socially disadvantaged patients

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Among socially disadvantaged patients with moderate or advanced chronic kidney disease, a simple five-variable model accurately predicts most cases of kidney failure that develop within five years. The model, which is described in an upcoming issue of the Journal of the American Society of Nephrology (JASN), can help predict who will progress to kidney failure and may help guide approaches to reduce socioeconomic disparities in kidney disease.

To look for ways to help municipal health systems identify socially disadvantaged patients at high risk for progression of CKD to ESRD, Marlena Maziarz, MSc, Yoshio Hall, MD, MS, from the University of Washington, Seattle, and their colleagues conducted a retrospective study of 28,779 adults with CKD who received health care in two large safety net health systems from 1996 to 2009 and were followed through September 2011.

Overall, 1,730 individuals progressed to ESRD during a median follow-up of 6.6 years. ESRD risk for time frames up to five years was highly concentrated among relatively few individuals. Using a predictive model that included five common variables—age, sex, race, kidney function, and dipstick urinary protein level—80% of individuals who eventually developed ESRD were among the 5% of individuals at the highest estimated risk for ESRD at 1 year. Similarly, a program that followed 8% and 13% of individuals at the highest ESRD risk would have included 80% of those who eventually progressed to ESRD at three and five years, respectively.

Therefore, in this underserved health setting, a simple five -variable model accurately predicted most cases of ESRD that developed within five years.

“Our study approach may help to guide public health systems in identifying a sub-cohort of patients who are at high risk for progressing to ESRD to provide, for example, more intensive surveillance, risk factor management, and, when necessary, preparation for ESRD care,” said Dr. Hall.

Study co-authors include R. Anthony Black, MA, Christine Fong, MS, Jonathan Himmelfarb, MD, and Glenn Chertow, MD, MPH.

The article, entitled “Evaluating Risk of ESRD in the Urban Poor,” appears online at http://jasn.asnjournals.org.