Multinational Assessment of Accuracy of Equations for Predicting Risk of Kidney Failure: A Meta-analysis
Navdeep Tangri,Morgan E. Grams,Andrew S. Levey,Josef Coresh,Lawrence J. Appel,Brad C. Astor,Gabriel Chodick,Allan J. Collins,Ognjenka Djurdjev,C Raina Elley,Marie Evans,Amit X. Garg,Stein Hallan,Lesley A. Inker,Sadayoshi Ito,Sun Ha Jee,Csaba P. Kovesdy,Csaba P. Kovesdy,Florian Kronenberg,Hiddo J.L. Heerspink,Angharad Marks,Girish N. Nadkarni,Sankar D. Navaneethan,Robert G. Nelson,Stephanie Titze,Mark J. Sarnak,Bénédicte Stengel,Mark Woodward,Mark Woodward,Mark Woodward,Kunitoshi Iseki +30 more
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Kidney failure risk equations developed in a Canadian population showed high discrimination and adequate calibration when validated in 31 multinational cohorts, but the original risk equations overestimated risk in some non-North American cohorts.Abstract:
Importance Identifying patients at risk of chronic kidney disease (CKD) progression may facilitate more optimal nephrology care. Kidney failure risk equations, including such factors as age, sex, estimated glomerular filtration rate, and calcium and phosphate concentrations, were previously developed and validated in 2 Canadian cohorts. Validation in other regions and in CKD populations not under the care of a nephrologist is needed. Objective To evaluate the accuracy of the risk equations across different geographic regions and patient populations through individual participant data meta-analysis. Data Sources Thirty-one cohorts, including 721 357 participants with CKD stages 3 to 5 in more than 30 countries spanning 4 continents, were studied. These cohorts collected data from 1982 through 2014. Study Selection Cohorts participating in the CKD Prognosis Consortium with data on end-stage renal disease. Data Extraction and Synthesis Data were obtained and statistical analyses were performed between July 2012 and June 2015. Using the risk factors from the original risk equations, cohort-specific hazard ratios were estimated and combined using random-effects meta-analysis to form new pooled kidney failure risk equations. Original and pooled kidney failure risk equation performance was compared, and the need for regional calibration factors was assessed. Main Outcomes and Measures Kidney failure (treatment by dialysis or kidney transplant). Results During a median follow-up of 4 years of 721 357 participants with CKD, 23 829 cases kidney failure were observed. The original risk equations achieved excellent discrimination (ability to differentiate those who developed kidney failure from those who did not) across all cohorts (overallCstatistic, 0.90; 95% CI, 0.89-0.92 at 2 years;Cstatistic at 5 years, 0.88; 95% CI, 0.86-0.90); discrimination in subgroups by age, race, and diabetes status was similar. There was no improvement with the pooled equations. Calibration (the difference between observed and predicted risk) was adequate in North American cohorts, but the original risk equations overestimated risk in some non-North American cohorts. Addition of a calibration factor that lowered the baseline risk by 32.9% at 2 years and 16.5% at 5 years improved the calibration in 12 of 15 and 10 of 13 non-North American cohorts at 2 and 5 years, respectively (P = .04 andP = .02). Conclusions and Relevance Kidney failure risk equations developed in a Canadian population showed high discrimination and adequate calibration when validated in 31 multinational cohorts. However, in some regions the addition of a calibration factor may be necessary.read more
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References
More filters
Journal ArticleDOI
A New Equation to Estimate Glomerular Filtration Rate
Andrew S. Levey,Lesley A. Stevens,Christopher H. Schmid,Yaping (Lucy) Zhang,Alejandro F. Castro,Harold I. Feldman,John W. Kusek,Paul W. Eggers,Frederick Van Lente,Tom Greene,Josef Coresh +10 more
TL;DR: The CKD-EPI creatinine equation is more accurate than the Modification of Diet in Renal Disease Study equation and could replace it for routine clinical use.
Journal ArticleDOI
Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization
TL;DR: The longitudinal glomerular filtration rate was estimated among 1,120,295 adults within a large, integrated system of health care delivery in whom serum creatinine had been measured between 1996 and 2000 and who had not undergone dialysis or kidney transplantation.
Journal ArticleDOI
Prevalence of Chronic Kidney Disease in the United States
Josef Coresh,Elizabeth Selvin,Lesley A. Stevens,Jane Manzi,John W. Kusek,Paul W. Eggers,Frederick Van Lente,Andrew S. Levey +7 more
TL;DR: The prevalence of CKD in the United States in 1999-2004 is higher than it was in 1988-1994 and this increase is partly explained by the increasing prevalence of diabetes and hypertension and raises concerns about future increased incidence of kidney failure and other complications.
Journal ArticleDOI
Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis.
Kunihiro Matsushita,Marije van der Velde,Brad C. Astor,Mark Woodward,Andrew S. Levey,Paul E. de Jong,Josef Coresh,Ron T. Gansevoort,Meguid El-Nahas,Kai-Uwe Eckardt,Bertram L. Kasiske,Marcello Tonelli,Brenda R. Hemmelgarn,Yaping Wang,Robert C. Atkins,Kevan R. Polkinghorne,Steven J. Chadban,Anoop Shankar,Ronald Klein,Barbara E.K. Klein,Haiyan Wang,Fang Wang,Luxia Zhang,Lisheng Liu,Michael G. Shlipak,Mark J. Sarnak,Ronit Katz,Linda Fried,Tazeen H. Jafar,M. Mazharul Islam,Juanita Hatcher,Neil R Poulter,Nish Chaturvedi,Dietrich Rothenbacher,Hermann Brenner,Elke Raum,Wolfgang Koenig,Caroline S. Fox,Shih-Jen Hwang,James B. Meigs,Massimo Cirillo,Stein Hallan,Stian Lydersen,Jostein Holmen,Paul Roderick,Dorothea Nitsch,Astrid E. Fletcher,Christopher J. Bulpitt,Takayoshi Ohkubo,Hirohito Metoki,Masaaki Nakayama,Masahiro Kikuya,Yutaka Imai,Simerjot K. Jassal,Elizabeth Barrett-Connor,Jaclyn Bergstrom,David G. Warnock,Paul Muntner,Suzanne E. Judd,William M. McClellan,Mary Cushman,George Howard,Leslie A. McClure,Sun Ha Jee,Heejin Kimm,Ji Eun Yun,Chi Pang Wen,Sung Feng Wen,Chwen Keng Tsao,Min Kuang Tsai,Johan Ärnlöv,Priscilla Auguste,Kasper Veldhuis,Laura Camarata,Beverly Thomas,Tom Manley +75 more
TL;DR: In this article, a meta-analysis of general population cohorts was conducted to assess the independent and combined associations of estimated glomerular filtration rate (eGFR) and albuminuria with mortality.
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