Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep;54(9):2335-2342.
doi: 10.1007/s11255-022-03138-z. Epub 2022 Feb 9.

Evaluation of a predictive model of end-stage kidney disease in a French-based cohort

Maxime Ingwiller  1   2 , Thierry Krummel  1 , Yves Dimitrov  3   2 , Clotilde Muller  4 , Julien Ott  3   2 , François Chantrel  5   2 , Alexandre Klein  6 , Thierry Hannedouche  7   8 ; CERENNE Research Group
Collaborators, Affiliations

Evaluation of a predictive model of end-stage kidney disease in a French-based cohort

Maxime Ingwiller et al. Int Urol Nephrol. 2022 Sep.

Abstract

Background: The risk of ESKD is highly heterogeneous among renal diseases, and risk scores were developed to account for multiple progression factors. Kidney failure risk equation (KFRE) is the most widely accepted, although external validation is scarce. The objective of this study was to evaluate the usefulness of this score in a French case-control cohort and test the pertinence of the proposed thresholds.

Methods: A retrospective case-control study comparing a group of patients starting renal replacement therapy (RRT) to a group of patients with CKD stages 3-5. Multivariate analysis to assess the predictors of ESKD risk. Discrimination of 4-, 6- and 8-variable scores using ROC curves and compared with eGFR alone and albumin/creatinine ratio (ACR) alone.

Results: 314 patients with a ratio of 1 case for 1 control. In multivariate analysis, increasing age and higher eGFR were associated with a lower risk of ESKD (OR 0.62, 95% CI 0.48-0.79; and OR 0.72, 95% CI 0.59-0.86, respectively). The log-transformed ACR was associated with a higher risk of ESKD (OR 1.25 per log unit, 95% CI 1.02-1.55). The 4-variable score was significantly higher in the RRT group than in the CKD-ND group, and was more efficient than the eGFR (AUROC 0.66, 95% CI 0.60-0.72, p = 0.018) and the log-transformed ACR (AUROC 0.63 95% CI 0.60-0.72, p = 0.0087) to predict ESKD. The 6-variable score including BP metrics and diabetes was not more discriminant as the 4-variable score. The 8-variable score had similar performance compared with the 4-score (AUROC 8-variable score: 0.70, 95% CI 0.64-0.76, p = 0.526). A 40% and 20% score thresholds were not superior to eGFR < 15 and 20 mL/min/1.73 m2, respectively. A 10% threshold was more specific than an eGFR < 30 mL/min/1.73 m2.

Conclusion: KFRE was highly discriminant between patients progressing to ESKD vs those non-progressing. The 4-variable score may help stratify renal risk and referral in the numerous patients with stage 3 CKD. Conversely, the proposed thresholds for creating vascular access or preemptive transplantation were not superior to eGFR alone.

Keywords: Chronic kidney disease; End-stage kidney disease; Prediction model; Progression; Risk score.

PubMed Disclaimer

References

    1. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu C (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351(13):1296–1305 - DOI
    1. Weiner DE, Tighiouart H, Amin MG et al (2004) Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: a pooled analysis of community-based studies. J Am Soc Nephrol 15(5):1307–1315 - DOI
    1. Gansevoort RT, Matsushita K, van der Velde M et al (2011) Lower estimated GFR and higher albuminuria are associated with adverse kidney outcomes. A collaborative meta-analysis of general and high-risk population cohorts. Kidney Int 80(1):93–104 - DOI
    1. James MT, Hemmelgarn BR, Tonelli M (2010) Early recognition and prevention of chronic kidney disease. Lancet 10(375):1296–1309 - DOI
    1. O’Hare AM, Choi AI, Bertenthal D et al (2007) Age affects outcomes in chronic kidney disease. J Am Soc Nephrol 18(10):2758–2765 - DOI

MeSH terms

LinkOut - more resources