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Zacharias, H.U.* ; Altenbuchinger, M.* ; Schultheiss, U.T.* ; Raffler, J. ; Kotsis, F.* ; Ghasemi, S.* ; Ali, I.* ; Kollerits, B.* ; Metzger, M.* ; Steinbrenner, I.* ; Sekula, P.* ; Massy, Z.A.* ; Combe, C.* ; Kalra, P.A.* ; Kronenberg, F.* ; Stengel, B.* ; Eckardt, K.U.* ; Köttgen, A.* ; Schmid, M.* ; Gronwald, W.* ; Oefner, P.J.*

A predictive model for progression of CKD to kidney failure based on routine laboratory tests.

Am. J. Kidney Dis. 79, 217-230.e1 (2022)
Postprint Forschungsdaten DOI
Open Access Green
RATIONALE & OBJECTIVE: Stratification of chronic kidney disease (CKD) patients at risk for progressing to end-stage kidney disease (ESKD) requiring kidney replacement therapy (KRT) is important for clinical decision-making and trial enrollment. STUDY DESIGN: Four independent prospective observational cohort studies. SETTING & PARTICIPANTS: The development cohort was comprised of 4,915 CKD patients and three independent validation cohorts were comprised of a total of 3,063. Patients were followed-up for approximately five years. NEW PREDICTORS & ESTABLISHED PREDICTORS: 22 demographic, anthropometric and laboratory variables commonly assessed in CKD patients. OUTCOMES: Progression to ESKD requiring KRT. ANALYTICAL APPROACH: A Least Absolute Shrinkage and Selection Operator (LASSO) Cox proportional hazards model was fit to select laboratory variables that best identified patients at high risk for ESKD. Model discrimination and calibration were assessed and compared against the 4-variable Tangri (T4) risk equation. Both used a resampling approach within the development cohort and in the validation cohorts using cause-specific concordance (C) statistics, net reclassification improvement, and calibration graphs. RESULTS: The newly derived 6-variable (Z6) risk score included serum creatinine, albumin, cystatin C and urea, as well as hemoglobin and the urine albumin-to-creatinine ratio. Based on the resampling approach, Z6 achieved a median C value of 0.909 (95% CI, 0.868-0.937) at two years after the baseline visit, whereas the T4 achieved a median C value of 0.855 (95% CI, 0.799-0.915). In the three independent validation cohorts, Z6 C values were 0.894, 0.921, and 0.891, whereas the T4 C values were 0.882, 0.913, and 0.862. LIMITATIONS: The Z6 was both derived and tested only in White European cohorts. CONCLUSIONS: A new risk equation, based on six routinely available laboratory tests facilitates identification of patients with CKD who are at high risk of progressing to ESKD.
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Publikationstyp Artikel: Journalartikel
Dokumenttyp Wissenschaftlicher Artikel
Schlagwörter German Chronic Kidney Disease Study ; Chronic Kidney Disease ; Kidney Failure Requiring Kidney Replacement Therapy ; Machine Learning ; Risk Equation; Regularization Paths; Renal-disease; Estimated Gfr; Gender; Risk; Association; Burden
ISSN (print) / ISBN 0272-6386
e-ISSN 1523-6838
Quellenangaben Band: 79, Heft: 2, Seiten: 217-230.e1 Artikelnummer: , Supplement: ,
Verlag Elsevier
Verlagsort 1600 John F Kennedy Boulevard, Ste 1800, Philadelphia, Pa 19103-2899 Usa
Begutachtungsstatus Peer reviewed
Förderungen Vifor
Else KroEuroner-Fresenius-Stiftung (NAKSYS), Bad Homburg, Germany
KfH Foundation for Preventive Medicine (Kuratorium fur Heimdialyse und Nierentransplantation e.V.-Stiftung PraEuroventivmedizin)
German Ministry of Education and Research (BMBF)
German Research Foundation (SFB1350 grant)
Shire
Agence Nationale de la Recherche
2010 national Programme Hospitalier de Recherche Clinique
Astellas
Lilly France
Sanofi-Genzyme
Merck Sharp & Dohme-Chibret (MSD France)
AstraZeneca
Vifor Fresenius
Otsuka Pharmaceutical
Baxter
GlaxoSmithKline (GSK)
Fresenius Medical Care
Amgen
German Federal Ministry of Education and Research (BMBF)