TY - JOUR
T1 - Predicting Kidney Failure, Cardiovascular Disease and Death in Advanced CKD Patients
AU - Ramspek, Chava L.
AU - Boekee, Rosemarijn
AU - Evans, Marie
AU - Heimburger, Olof
AU - Snead, Charlotte M.
AU - Caskey, Fergus J.
AU - Torino, Claudia
AU - EQUAL Study Investigators
AU - Porto, Gaetana
AU - Szymczak, Maciej
AU - Krajewska, Magdalena
AU - Drechsler, Christiane
AU - Wanner, Christoph
AU - Chesnaye, Nicholas C.
AU - Jager, Kitty J.
AU - Dekker, Friedo W.
AU - Snoeijs, Maarten G. J.
AU - Rotmans, Joris I.
AU - van Diepen, Merel
AU - Cupisti, Adamasco
AU - Sagliocca, Adelia
AU - Ferraro, Alberto
AU - Musiała, Aleksandra
AU - Mele, Alessandra
AU - Naticchia, Alessandro
AU - Còsaro, Alex
AU - Woodman, Alistair
AU - Ranghino, Andrea
AU - Stucchi, Andrea
AU - Jonsson, Andreas
AU - Schneider, Andreas
AU - Pignataro, Angelo
AU - Schrander, Anita
AU - Torp, Anke
AU - McKeever, Anna
AU - Szymczak, Anna
AU - Blom, Anna-Lena
AU - de Blasio, Antonella
AU - Pani, Antonello
AU - Tsalouichos, Aris
AU - Ullah, Asad
AU - McLaren, Barbara
AU - van Dam, Bastiaan
AU - Iwig, Beate
AU - Antonio, Bellasi
AU - di Iorio, Biagio Raffaele
AU - Rogland, Björn
AU - Perras, Boris
AU - Vogt, Liffert
AU - Vervloet, Marc
AU - van Esch, Sadie
AU - Alessandra, Butti
N1 - Funding Information: All patients and health professionals involved in the EQUAL study are greatfully acknowledged. The work on this study by CLR was supported by a grant from the Dutch Kidney Foundation (20OK016). The work on this study by MvD was supported by grants from the Dutch Kidney Foundation (16OKG12 & 20OK016). Main funding for the EQUAL study was received from the European Renal Association–European Dialysis and Transplant Association and contributions from the Swedish Medical Association, the Stockholm County Council ALF Medicine and Center for Innovative research, the Italian Society of Nephrology, the Dutch Kidney Foundation, the Young Investigators grant in Germany, and the National Institute for Health Research in the United Kingdom. The EQUAL study was approved by the medical ethics committee or institutional review boards (as appropriate) of all participating centers (main medical ethical committee approval obtained in the Amsterdam Medical Center, NL38874.018.11). Written informed consent was obtained from all patients. Data are not publicly available. Data from the EQUAL study may be requested with protocol and statistical analysis plan at the EQUAL publication committee (contact: n.c.chesnaye@amterdamumc.nl). Funding Information: The work on this study by CLR was supported by a grant from the Dutch Kidney Foundation (20OK016). The work on this study by MvD was supported by grants from the Dutch Kidney Foundation (16OKG12 & 20OK016). Main funding for the EQUAL study was received from the European Renal Association–European Dialysis and Transplant Association and contributions from the Swedish Medical Association, the Stockholm County Council ALF Medicine and Center for Innovative research, the Italian Society of Nephrology, the Dutch Kidney Foundation, the Young Investigators grant in Germany, and the National Institute for Health Research in the United Kingdom. Publisher Copyright: © 2022 International Society of Nephrology
PY - 2022/10
Y1 - 2022/10
N2 - Introduction: Predicting the timing and occurrence of kidney replacement therapy (KRT), cardiovascular events, and death among patients with advanced chronic kidney disease (CKD) is clinically useful and relevant. We aimed to externally validate a recently developed CKD G4+ risk calculator for these outcomes and to assess its potential clinical impact in guiding vascular access placement. Methods: We included 1517 patients from the European Quality (EQUAL) study, a European multicentre prospective cohort study of nephrology-referred advanced CKD patients aged ≥65 years. Model performance was assessed based on discrimination and calibration. Potential clinical utility for timing of referral for vascular access placement was studied with diagnostic measures and decision curve analysis (DCA). Results: The model showed a good discrimination for KRT and “death after KRT,” with 2-year concordance (C) statistics of 0.74 and 0.76, respectively. Discrimination for cardiovascular events (2-year C-statistic: 0.70) and overall death (2-year C-statistic: 0.61) was poorer. Calibration was fairly accurate. Decision curves illustrated that using the model to guide vascular access referral would generally lead to less unused arteriovenous fistulas (AVFs) than following estimated glomerular filtration rate (eGFR) thresholds. Conclusion: This study shows moderate to good predictive performance of the model in an older cohort of nephrology-referred patients with advanced CKD. Using the model to guide referral for vascular access placement has potential in combating unnecessary vascular surgeries.
AB - Introduction: Predicting the timing and occurrence of kidney replacement therapy (KRT), cardiovascular events, and death among patients with advanced chronic kidney disease (CKD) is clinically useful and relevant. We aimed to externally validate a recently developed CKD G4+ risk calculator for these outcomes and to assess its potential clinical impact in guiding vascular access placement. Methods: We included 1517 patients from the European Quality (EQUAL) study, a European multicentre prospective cohort study of nephrology-referred advanced CKD patients aged ≥65 years. Model performance was assessed based on discrimination and calibration. Potential clinical utility for timing of referral for vascular access placement was studied with diagnostic measures and decision curve analysis (DCA). Results: The model showed a good discrimination for KRT and “death after KRT,” with 2-year concordance (C) statistics of 0.74 and 0.76, respectively. Discrimination for cardiovascular events (2-year C-statistic: 0.70) and overall death (2-year C-statistic: 0.61) was poorer. Calibration was fairly accurate. Decision curves illustrated that using the model to guide vascular access referral would generally lead to less unused arteriovenous fistulas (AVFs) than following estimated glomerular filtration rate (eGFR) thresholds. Conclusion: This study shows moderate to good predictive performance of the model in an older cohort of nephrology-referred patients with advanced CKD. Using the model to guide referral for vascular access placement has potential in combating unnecessary vascular surgeries.
KW - CKD
KW - cardiovascular disease
KW - death
KW - external validation
KW - kidney failure
KW - prognostic model
UR - http://www.scopus.com/inward/record.url?scp=85136309664&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ekir.2022.07.165
DO - https://doi.org/10.1016/j.ekir.2022.07.165
M3 - Article
C2 - 36217520
SN - 2468-0249
VL - 7
SP - 2230
EP - 2241
JO - Kidney International Reports
JF - Kidney International Reports
IS - 10
ER -