Study: More stringent algorithms may better define CKD stage G4
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Key takeaways:
- Researchers evaluated four increasingly stringent eGFR-based algorithms for patients with CKD.
- The results could refine disease definitions in clinical reporting systems and research.
Using more stringent algorithms to define chronic kidney disease stage G4 may lead to lower estimates of disease incidence and a higher risk of kidney failure, researchers found.
“We aimed to assess the differences in size, baseline characteristics, incidence and prognosis of resulting cohorts,” Mitchell Rath, MDSA, BSc, of the Alberta Health Services, Provincial Research and Data Services in Alberta, Canada, wrote along with colleagues. “Comparison of different criteria to define CKD G4 can be used to inform referral decisions.”
Researchers conducted a population-based cohort study with Alberta residents eligible for public health insurance and selected a subset of patients with incident CKD G4, defined as an eGFR between 15 mL/min/1.73 m2 and 29 mL/min/1.73 m2 and diagnosed between 2015 and 2018 for evaluation.
Investigators evaluated four outpatient eGFR-based algorithms, each more stringent than the previous: a single test, a two-test sequence, sustained reductions in eGFR and rigorous sustained reductions in eGFR.
Primary outcome measurements included time to the earliest of death, eGFR improvement (a sustained increase in eGFR to at least 30 mL/min/1.73 m2 for more than 90 days with a greater than 25% increase from the index eGFR) or kidney failure.
The cohort size decreased with the use of more stringent algorithms: 18,081 by single test; 11,054 by two tests; 7,695 by relaxed sustained reductions; and 7,571 by rigorous sustained reductions.
According to the findings, as the algorithms became more stringent, incidence rates of CKD G4 decreased. Incidence ranged from 190.7 per 100,000 person-years for the single test algorithm to 79.9 per 100,000 person-years for the rigorous sustained algorithm.
The cohorts based on sustained eGFR reductions showed comparable sizes and 1-year event-specific probabilities, the researchers noted. The groups relying on a single test and a two-test sequence were larger with higher probabilities of eGFR improvement.
Limitations included a short follow-up period and a population of predominately white patients, according to the study.
Future work may “inform implementation decisions of disease definitions in clinical reporting systems and research studies,” Rath and colleagues wrote.
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