TY - JOUR
T1 - Predicting timing of clinical outcomes in patients with chronic kidney disease and severely decreased glomerular filtration rate
AU - Grams, Morgan E.
AU - Sang, Yingying
AU - Ballew, Shoshana H.
AU - Carrero, Juan Jesus
AU - Djurdjev, Ognjenka
AU - Heerspink, Hiddo J.L.
AU - Ho, Kevin
AU - Ito, Sadayoshi
AU - Marks, Angharad
AU - Naimark, David
AU - Nash, Danielle M.
AU - Navaneethan, Sankar D.
AU - Sarnak, Mark
AU - Stengel, Benedicte
AU - Visseren, Frank L.J.
AU - Wang, Angela Yee Moon
AU - Köttgen, Anna
AU - Levey, Andrew S.
AU - Woodward, Mark
AU - Eckardt, Kai Uwe
AU - Hemmelgarn, Brenda
AU - Coresh, Josef
N1 - Publisher Copyright:
© 2018 International Society of Nephrology
PY - 2018/6/1
Y1 - 2018/6/1
N2 - Patients with chronic kidney disease and severely decreased glomerular filtration rate (GFR) are at high risk for kidney failure, cardiovascular disease (CVD) and death. Accurate estimates of risk and timing of these clinical outcomes could guide patient counseling and therapy. Therefore, we developed models using data of 264,296 individuals in 30 countries participating in the international Chronic Kidney Disease Prognosis Consortium with estimated GFR (eGFR)s under 30 ml/min/1.73m2. Median participant eGFR and urine albumin-to-creatinine ratio were 24 ml/min/1.73m2 and 168 mg/g, respectively. Using competing-risk regression, random-effect meta-analysis, and Markov processes with Monte Carlo simulations, we developed two- and four-year models of the probability and timing of kidney failure requiring kidney replacement therapy (KRT), a non-fatal CVD event, and death according to age, sex, race, eGFR, albumin-to-creatinine ratio, systolic blood pressure, smoking status, diabetes mellitus, and history of CVD. Hypothetically applied to a 60-year-old white male with a history of CVD, a systolic blood pressure of 140 mmHg, an eGFR of 25 ml/min/1.73m2 and a urine albumin-to-creatinine ratio of 1000 mg/g, the four-year model predicted a 17% chance of survival after KRT, a 17% chance of survival after a CVD event, a 4% chance of survival after both, and a 28% chance of death (9% as a first event, and 19% after another CVD event or KRT). Risk predictions for KRT showed good overall agreement with the published kidney failure risk equation, and both models were well calibrated with observed risk. Thus, commonly-measured clinical characteristics can predict the timing and occurrence of clinical outcomes in patients with severely decreased GFR.
AB - Patients with chronic kidney disease and severely decreased glomerular filtration rate (GFR) are at high risk for kidney failure, cardiovascular disease (CVD) and death. Accurate estimates of risk and timing of these clinical outcomes could guide patient counseling and therapy. Therefore, we developed models using data of 264,296 individuals in 30 countries participating in the international Chronic Kidney Disease Prognosis Consortium with estimated GFR (eGFR)s under 30 ml/min/1.73m2. Median participant eGFR and urine albumin-to-creatinine ratio were 24 ml/min/1.73m2 and 168 mg/g, respectively. Using competing-risk regression, random-effect meta-analysis, and Markov processes with Monte Carlo simulations, we developed two- and four-year models of the probability and timing of kidney failure requiring kidney replacement therapy (KRT), a non-fatal CVD event, and death according to age, sex, race, eGFR, albumin-to-creatinine ratio, systolic blood pressure, smoking status, diabetes mellitus, and history of CVD. Hypothetically applied to a 60-year-old white male with a history of CVD, a systolic blood pressure of 140 mmHg, an eGFR of 25 ml/min/1.73m2 and a urine albumin-to-creatinine ratio of 1000 mg/g, the four-year model predicted a 17% chance of survival after KRT, a 17% chance of survival after a CVD event, a 4% chance of survival after both, and a 28% chance of death (9% as a first event, and 19% after another CVD event or KRT). Risk predictions for KRT showed good overall agreement with the published kidney failure risk equation, and both models were well calibrated with observed risk. Thus, commonly-measured clinical characteristics can predict the timing and occurrence of clinical outcomes in patients with severely decreased GFR.
KW - albuminuria
KW - cardiovascular disease
KW - chronic kidney disease
UR - http://www.scopus.com/inward/record.url?scp=85044330182&partnerID=8YFLogxK
U2 - 10.1016/j.kint.2018.01.009
DO - 10.1016/j.kint.2018.01.009
M3 - Article
AN - SCOPUS:85044330182
SN - 0085-2538
VL - 93
SP - 1442
EP - 1451
JO - Kidney International
JF - Kidney International
IS - 6
ER -