Back to Search
Start Over
Predicting timing of clinical outcomes in patients with chronic kidney disease and severely decreased glomerular filtration rate.
- Source :
-
Kidney international [Kidney Int] 2018 Jun; Vol. 93 (6), pp. 1442-1451. Date of Electronic Publication: 2018 Mar 29. - Publication Year :
- 2018
-
Abstract
- Patients with chronic kidney disease and severely decreased glomerular filtration rate (GFR) are at high risk for kidney failure, cardiovascular disease (CVD) and death. Accurate estimates of risk and timing of these clinical outcomes could guide patient counseling and therapy. Therefore, we developed models using data of 264,296 individuals in 30 countries participating in the international Chronic Kidney Disease Prognosis Consortium with estimated GFR (eGFR)s under 30 ml/min/1.73m <superscript>2</superscript> . Median participant eGFR and urine albumin-to-creatinine ratio were 24 ml/min/1.73m <superscript>2</superscript> and 168 mg/g, respectively. Using competing-risk regression, random-effect meta-analysis, and Markov processes with Monte Carlo simulations, we developed two- and four-year models of the probability and timing of kidney failure requiring kidney replacement therapy (KRT), a non-fatal CVD event, and death according to age, sex, race, eGFR, albumin-to-creatinine ratio, systolic blood pressure, smoking status, diabetes mellitus, and history of CVD. Hypothetically applied to a 60-year-old white male with a history of CVD, a systolic blood pressure of 140 mmHg, an eGFR of 25 ml/min/1.73m <superscript>2</superscript> and a urine albumin-to-creatinine ratio of 1000 mg/g, the four-year model predicted a 17% chance of survival after KRT, a 17% chance of survival after a CVD event, a 4% chance of survival after both, and a 28% chance of death (9% as a first event, and 19% after another CVD event or KRT). Risk predictions for KRT showed good overall agreement with the published kidney failure risk equation, and both models were well calibrated with observed risk. Thus, commonly-measured clinical characteristics can predict the timing and occurrence of clinical outcomes in patients with severely decreased GFR.<br /> (Copyright © 2018 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Aged
Cardiovascular Diseases mortality
Cardiovascular Diseases physiopathology
Cardiovascular Diseases therapy
Disease Progression
Female
Humans
Male
Markov Chains
Middle Aged
Monte Carlo Method
Prognosis
Renal Insufficiency mortality
Renal Insufficiency physiopathology
Renal Insufficiency therapy
Renal Insufficiency, Chronic mortality
Renal Insufficiency, Chronic physiopathology
Renal Insufficiency, Chronic therapy
Renal Replacement Therapy
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
Cardiovascular Diseases etiology
Decision Support Techniques
Glomerular Filtration Rate
Kidney physiopathology
Renal Insufficiency etiology
Renal Insufficiency, Chronic complications
Subjects
Details
- Language :
- English
- ISSN :
- 1523-1755
- Volume :
- 93
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Kidney international
- Publication Type :
- Academic Journal
- Accession number :
- 29605094
- Full Text :
- https://doi.org/10.1016/j.kint.2018.01.009