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. 2017 Jan 6;12(1):87-94.
doi: 10.2215/CJN.01290216. Epub 2016 Dec 27.

Predicting 5-Year Risk of RRT in Stage 3 or 4 CKD: Development and External Validation

Emily B Schroeder  1   2 , Xiuhai Yang  3 , Micah L Thorp  4 , Brent M Arnold  5 , David C Tabano  1 , Amanda F Petrik  3 , David H Smith  3 , Robert W Platt  6 , Eric S Johnson  3
Affiliations

Predicting 5-Year Risk of RRT in Stage 3 or 4 CKD: Development and External Validation

Emily B Schroeder et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: Only a minority of patients with CKD progress to renal failure. Despite the potential benefits of risk stratification in the CKD population, risk prediction models are not routinely used. Our objective was to develop and externally validate a clinically useful and pragmatic prediction model for the 5-year risk of progression to RRT in stage 3 or 4 CKD.

Design, setting, participants, & measurements: We used a retrospective cohort design. The development cohort consisted of 22,460 Kaiser Permanente Northwest members with stage 3 or 4 CKD (baseline 2002-2008). The validation cohort consisted of 16,553 Kaiser Permanente Colorado members with stage 3-4 CKD (baseline 2006-2008). The final model included eight predictors: age, sex, eGFR, hemoglobin, proteinuria/albuminuria, systolic BP, antihypertensive medication use, and diabetes and its complications.

Results: In the Northwest and Colorado cohorts, there were 737 and 360 events, and observed 5-year Kaplan-Meier risks of 4.72% (95% confidence interval [95% CI], 4.38 to 5.06) and 2.57% (95% CI, 2.30 to 2.83), respectively. Our prediction model performed extremely well in the development cohort, with a c-statistic of 0.96, an R2 of 79.7%, and good calibration. We had similarly good performance in the external validation cohort, with a c-statistic of 0.95, R2 of 81.2%, and good calibration. In the external validation cohort, the observed risk was slightly lower than the predicted risk in the highest-risk quintile. Using the top quintile of predicted risk as a cutpoint gave a sensitivity of 92.2%.

Conclusions: We developed a pragmatic prediction model and risk score for predicting the 5-year RRT risk in stage 3 and 4 CKD. This model uses variables that are typically available in routine primary care settings, and can be used to help guide important decisions such as timing of referral to nephrology and fistula placement.

Keywords: Antihypertensive Agents; Calibration; Colorado; Fistula; Hemoglobins; Humans; Primary Health Care; Referral and Consultation; Renal Insufficiency; albuminuria; blood pressure; chronic kidney disease; clinical prediction rule; diabetes mellitus; disease progression; glomerular filtration rate; nephrology; prognosis; proteinuria; renal failure; renal insufficiency, chronic; renal replacement therapy; retrospective studies; risk assessment.

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Figures

Figure 1.
Figure 1.
Predicted and observed 5-year risk by quintile of predicted risk from the Kaiser Permanente Northwest prediction model. (A) Northwest cohort (development cohort). (B) Colorado cohort (external validation cohort).
See this image and copyright information in PMC

Comment in

  • Predicting Risk of RRT in Patients with CKD.
    Grams ME, Coresh J. Grams ME, et al. Clin J Am Soc Nephrol. 2017 Jan 6;12(1):3-4. doi: 10.2215/CJN.11841116. Epub 2016 Dec 27. Clin J Am Soc Nephrol. 2017. PMID: 28028049 Free PMC article. No abstract available.

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