Kidney failure risk equation had ‘better clinical utility’ than eGFR for patients with CKD
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Key takeaways:
- C-statistics were .750 during 2 years in a 4-variable model and .756 in an 8-year model.
- The risk equation outperformed the eGFR-based strategy across various net benefit thresholds.
A kidney failure risk equation model had acceptable discrimination and calibration, and “better clinical utility” than an eGFR-based strategy to assess kidney failure rates in Chinese patients, according to a study in Kidney Medicine.
“Accurate and reliable risk evaluation of chronic kidney disease (CKD) prognosis can be helpful for physicians to make decisions concerning treatment opportunity and therapeutic strategy,” Ling Pan, MD, of the renal division at Peking University First Hospital in Beijing, China, and colleagues wrote in a study. “Chinese patients with CKD may represent different etiologic patterns and undergo different clinical management than their western counterparts.”
Researchers ran the community-based urban study to evaluate adults with CKD, defined as an eGFR below 60 mL/min/1.73 m2, who reside in an industrialized coastal city of China. The goal was to externally validate the kidney failure risk equation (KFRE).
Overall, 4,587 patients were enrolled for validation of a four-variable model, while 1,414 patients were designated to an eight-variable model. Median follow-up for the first group was 4 years and 3.4 years for the second. The study accounted for age, sex, eGFR and albuminuria in the four-variable model, and the eight-variable model added serum calcium, phosphate, bicarbonate and albumin.
The main outcome was initiation of chronic dialysis treatment.
In the four-variable model, C-statistics were .750 for the 2-year model and .766 for the 5-year model. Meanwhile, in the eight-variable model, the numbers were .756 and .774, respectively. Calibration was acceptable for both models, according to the researchers, and decision curve analysis showed the risk equation outperformed the eGFR-based strategy across various net benefit thresholds for a 5-year scale.
Researchers identified limitations such as a lack of albuminuria measurements in a significant proportion of patients and incomplete data for the eight-variable equation in only a subset of the population, but reported overall “acceptable performance” of the KFRE in predicting kidney failure incidence with replacement therapy.
“Further studies in China from various settings are needed to evaluate the accuracy of KFRE,” they wrote, “as well as those evaluating the effect of using the equations to prevent the progression of CKD.”
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