医学
内科学
比例危险模型
肾脏疾病
肾功能
肌酐
危险系数
一致性
队列
置信区间
作者
Helena U. Zacharias,Michael Altenbuchinger,Ulla T. Schultheiß,Johannes Raffler,Fruzsina Kotsis,Sahar Ghasemi,Ibrahim Ali,Barbara Kollerits,Marie Metzger,Inga Steinbrenner,Peggy Sekula,Ziad A. Massy,Christian Combe,Philip A. Kalra,Florian Kronenberg,Bénédicte Stengel,Kai‐Uwe Eckardt,Anna Köttgen,Matthias Schmid,Wolfram Gronwald,Peter J. Oefner
标识
DOI:10.1053/j.ajkd.2021.05.018
摘要
Stratification of chronic kidney disease (CKD) patients at risk for progressing to kidney failure requiring kidney replacement therapy (KFRT) is important for clinical decision-making and trial enrollment.Four independent prospective observational cohort studies.The development cohort comprised 4,915 CKD patients, and 3 independent validation cohorts comprised a total of 3,063. Patients were observed for approximately 5 years.22 demographic, anthropometric, and laboratory variables commonly assessed in CKD patients.Progression to KFRT.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 KFRT. Model discrimination and calibration were assessed and compared against the 4-variable Tangri (T4) risk equation both in a resampling approach within the development cohort and in the validation cohorts using cause-specific concordance (C) statistics, net reclassification improvement, and calibration graphs.The newly derived 6-variable risk score (Z6) included serum creatinine, albumin, cystatin C, and urea, as well as hemoglobin and the urinary albumin-creatinine ratio. In the the resampling approach, Z6 achieved a median C statistic of 0.909 (95% CI, 0.868-0.937) at 2 years after the baseline visit, whereas the T4 achieved a median C statistic of 0.855 (95% CI, 0.799-0.915). In the 3 independent validation cohorts, the Z6C statistics were 0.894, 0.921, and 0.891, whereas the T4C statistics were 0.882, 0.913, and 0.862.The Z6 was both derived and tested only in White European cohorts.A new risk equation based on 6 routinely available laboratory tests facilitates identification of patients with CKD who are at high risk of progressing to KFRT.
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