■肾衰竭风险方程已被证明在跨国数据库中表现良好,而在亚洲人群中缺乏验证。这项研究试图在中国社区慢性肾脏病队列中从外部验证这些方程。
■一项回顾性队列研究。
■在中国沿海工业化城市居住的肾小球滤过率(eGFR)<60mL/min/1.73m2的患者。
■年龄,性别,eGFR,和蛋白尿包括在4变量模型中,而血清钙,磷酸盐,碳酸氢盐,和白蛋白水平被添加到8变量模型中先前提到的变量中。
■开始长期透析治疗。
■模型判别,校准,临床效用由Harrell的C统计量进行评估,校准图,和决策曲线分析,分别。
■共有4,587名参与者参加了4变量模型的验证,而1,414人被纳入8变量模型。4变量模型的中位随访时间为4.0(四分位距:2.6-6.3)年,8变量模型的中位随访时间为3.4(2.2-5.6)年。对于4变量模型,2年期模型的C统计数据为0.750(95%CI:0.615-0.885),5年期模型为0.766(0.625-0.907),而值分别为0.756(0.629-0.883)和0.774(0.641-0.907),分别,对于8变量模型。4变量和8变量模型的校准都是可接受的。与基于eGFR(<30mL/min/1.73m2)的策略相比,在5年规模的模型的决策曲线分析在不同的净收益阈值中表现更好。
■很大比例的患者缺乏蛋白尿测量,只有一部分人口可以为8变量方程提供完整的数据。
■肾衰竭风险方程显示出可接受的辨别和校准,并且比基于eGFR的策略在中国城市慢性肾脏病社区患者中肾衰竭发病率方面具有更好的临床实用性。
对慢性肾脏病(CKD)预后进行准确可靠的风险评估有助于医师做出有关治疗时机和治疗策略的决策。肾衰竭风险方程是预测CKD患者肾衰竭风险的优秀模型。然而,该方程在中国人群中缺乏验证。在目前的研究中,我们证明,该方程在中国以城市社区为基础的CKD患者队列中具有良好的区分度.校准也是可以接受的。决策曲线分析还表明,该方程的性能优于传统的基于肾功能的策略。该结果为使用来自肾衰竭风险方程的预测来改善中国社区CKD患者的管理提供了依据。
UNASSIGNED: The Kidney Failure Risk Equations have been proven to perform well in multinational databases, whereas validation in Asian populations is lacking. This study sought to externally validate the equations in a community-based chronic kidney disease cohort in
China.
UNASSIGNED: A retrospective cohort study.
UNASSIGNED: Patients with and estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 dwelling in an industrialized coastal city of
China.
UNASSIGNED: Age, sex, eGFR, and albuminuria were included in the 4-variable model, whereas serum calcium, phosphate, bicarbonate, and albumin levels were added to the previously noted variables in the 8-variable model.
UNASSIGNED: Initiation of long-term dialysis treatment.
UNASSIGNED: Model discrimination, calibration, and clinical utility were evaluated by Harrell\'s C statistic, calibration plots, and decision curve analysis, respectively.
UNASSIGNED: A total of 4,587 participants were enrolled for validation of the 4-variable model, whereas 1,414 were enrolled for the 8-variable model. The median times of follow-up were 4.0 (interquartile range: 2.6-6.3) years for the 4-variable model and 3.4 (2.2-5.6) years for the 8-variable model. For the 4-variable model, the C statistics were 0.750 (95% CI: 0.615-0.885) for the 2-year model and 0.766 (0.625-0.907) for the 5-year model, whereas the values were 0.756 (0.629-0.883) and 0.774 (0.641-0.907), respectively, for the 8-variable model. Calibration was acceptable for both the 4-variable and 8-variable models. Decision curve analysis for the models at the 5-year scale performed better throughout different net benefit thresholds than the eGFR-based (<30 mL/min/1.73 m2) strategy.
UNASSIGNED: A large proportion of patients lack albuminuria measurements, and only a subset of population could provide complete data for the 8-variable equation.
UNASSIGNED: The kidney failure risk equations showed acceptable discrimination and calibration and better clinical utility than the eGFR-based strategy for incidence of kidney failure among community-based urban Chinese patients with chronic kidney disease.
Accurate and reliable risk evaluation of chronic kidney disease (CKD) prognosis can be helpful for physicians to make decisions concerning treatment opportunity and therapeutic strategy. The kidney failure risk equation is an outstanding model for predicting risk of kidney failure among patients with CKD. However, the equation is lacking validation among Chinese populations. In the current study, we demonstrated that the equation had good discrimination among an urban community-based cohort of patients with CKD in
China. The calibration was also acceptable. Decision curve analysis also showed that the equation performed better than a traditional kidney function-based strategy. The results provide the basis for using predictions derived from the kidney failure risk equation to improve the management of patients with CKD in community settings in
China.