Abstract
Background
Predicting the timing and occurrence of kidney replacement therapy (KRT), cardiovascular events and death in 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 EQUAL study, a European multi-centre 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.
Results
The model showed a good discrimination for KRT and ‘death after KRT’, with 2-year 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 than following eGFR thresholds.
Conclusion
This study shows moderate to good predictive performance of the model in an older cohort of nephrology-referred advanced CKD patients. Using the model to guide referral for vascular access placement has potential in combatting unnecessary vascular surgeries.
Predicting the timing and occurrence of kidney replacement therapy (KRT), cardiovascular events and death in 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 EQUAL study, a European multi-centre 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.
Results
The model showed a good discrimination for KRT and ‘death after KRT’, with 2-year 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 than following eGFR thresholds.
Conclusion
This study shows moderate to good predictive performance of the model in an older cohort of nephrology-referred advanced CKD patients. Using the model to guide referral for vascular access placement has potential in combatting unnecessary vascular surgeries.
| Original language | English |
|---|---|
| Pages (from-to) | 2230-2241 |
| Number of pages | 12 |
| Journal | Kidney international reports |
| Volume | 7 |
| Issue number | 10 |
| Early online date | 2 Aug 2022 |
| DOIs | |
| Publication status | Published - 3 Oct 2022 |
Bibliographical note
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: [email protected]).
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
Keywords
- cardiovascular disease
- CKD
- death
- external validation
- kidney failure
- prognostic model
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This is the final published version of the article (version of record). It first appeared online via Elsevier at https://doi.org/10.1016/j.ekir.2022.07.165. Please refer to any applicable terms of use of the publisher.