Multinational Assessment of Accuracy of Equations for Predicting Risk of Kidney Failure: A Meta-analysis.
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Version: Final published version
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Download: Supplementary material.pdf (1813.03 [Ko])
State: Public
Version: Supplementary document
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State: Public
Version: Supplementary document
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Serval ID
serval:BIB_3CB3B5BCF837
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Multinational Assessment of Accuracy of Equations for Predicting Risk of Kidney Failure: A Meta-analysis.
Journal
JAMA
Working group(s)
CKD Prognosis Consortium
Contributor(s)
Wright J.T., Appel L.J., Greene T., Astor B.C., Coresh J., Matsushita K., Grams M.E., Sang Y., Levin A., Djurdjev O., Navaneethan S.D., Nally J.V., Schold J.D., Wheeler D.C., Emberson J., Townend J.N., Landray M.J., Appel L.J., Feldman H., Hsu C.Y., Eckardt K.U., Kottgen A., Kronenberg F., Titze S., Green J., Kirchner H., Perkins R., Chang A.R., Black C., Marks A., Fluck N., Clark L., Prescott G.J., Ito S., Miyazaki M., Nakayama M., Yamada G., Hallan S., Aasarød K., Romundstad S., Smith D.H., Thorp M.L., Johnson E.S., Collins A.J., Chen S.C., Li S., Chodick G., Shalev V., Ash N., Shainberg B., Wetzels J.F., Blankestijn P.J., van Zuilen A.D., Sarnak M.J., Levey A.S., Inker L.A., Menon V., Kronenberg F., Kollerits B., Ritz E., Nadkarni G.N., Bottinger E.P., Ellis S.B., Nadukuru R., Froissart M., Stengel B., Metzger M., Haymann J.P., Houillier P., Flamant M., Elley C., Kenealy T., Moyes S.A., Collins J.F., Drury P.L., Iseki K., Garg A.X., McArthur E., Nesrallah G., Kim S.J., Nelson R.G., Knowler W.C., Warnock D.G., Muntner P., Judd S., McClellan W., Gutierrez O., Heerspink H.J., Brenner B.E., de Zeeuw D., Jee S.H., Kimm H., Mok Y., Evans M., Stendahl M., Tangri N., Sud M., Naimark D., Kovesdy C.P., Kalantar-Zadeh K., Coresh J., Gansevoort R.T., Grams M.E., de Jong P.E., Iseki K., Levey A.S., Matsushita K., Sarnak M.J., Stengel B., Warnock D., Woodward M., Ballew S.H., Coresh J., Grams M.E., Matsushita K., Sang Y., Woodward M.
ISSN
1538-3598 (Electronic)
ISSN-L
0098-7484
Publication state
Published
Issued date
12/01/2016
Peer-reviewed
Oui
Volume
315
Number
2
Pages
164-174
Language
english
Notes
Publication types: Journal Article ; Meta-Analysis ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Publication Status: ppublish
Abstract
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.
To evaluate the accuracy of the risk equations across different geographic regions and patient populations through individual participant data meta-analysis.
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.
Cohorts participating in the CKD Prognosis Consortium with data on end-stage renal disease.
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.
Kidney failure (treatment by dialysis or kidney transplant).
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 (overall C statistic, 0.90; 95% CI, 0.89-0.92 at 2 years; C statistic 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 and P = .02).
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.
To evaluate the accuracy of the risk equations across different geographic regions and patient populations through individual participant data meta-analysis.
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.
Cohorts participating in the CKD Prognosis Consortium with data on end-stage renal disease.
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.
Kidney failure (treatment by dialysis or kidney transplant).
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 (overall C statistic, 0.90; 95% CI, 0.89-0.92 at 2 years; C statistic 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 and P = .02).
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.
Keywords
Cohort Studies, Disease Progression, Humans, Prognosis, Proportional Hazards Models, Renal Insufficiency/epidemiology, Renal Insufficiency, Chronic/complications, Risk Assessment
Pubmed
Web of science
Open Access
Yes
Create date
09/03/2018 18:15
Last modification date
06/08/2024 7:34
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