背景:慢性肾病(CKD)的后果可以通过一系列主要由肾病学家开出的药物疗法来解决。关于未来CKD相关药物治疗要求的更准确信息可以指导临床决策,包括随访频率。
方法:在分配给推导和验证组(2,1)之后,预测未来单独使用维生素D受体激动剂(VDRA)的变量,磷酸盐粘合剂,红细胞生成刺激剂(ESAs)和铁在包含人口统计学的前瞻性队列研究中使用逻辑回归进行鉴定,合并症,住院治疗,实验室,6个欧洲国家CKDG4/G5期患者的死亡率数据。辨别能力是用C统计量来衡量的,和预测的药物使用概率用于告知随访频率。
结果:共2196例患者纳入分析。在735天的中位随访期间,648开始了血液透析,1548没有。年龄的组合,糖尿病状态和iPTH,钙,血红蛋白和血清白蛋白水平预测欧空局的使用,铁,磷酸盐粘合剂或VDRA,推导队列中的C统计量分别为0.70、0.64、0.73和0.63。验证队列中的模型性能相似。预计16%的患者接受这些药物的可能性低于20%。
结论:在多国CKD队列中,可以根据患者特征预测ESA和磷酸盐结合剂在两年内的使用情况,从而有可能降低需要这些药物的低风险个体的随访频率.
BACKGROUND: The consequences of chronic kidney disease (CKD) can be addressed with a range of pharmacotherapies primarily prescribed by nephrologists. More accurate information regarding future CKD-related pharmacotherapy requirements could guide clinical decisions including follow-up frequency.
METHODS: Following assignment to derivation and validation groups (2,1), variables predicting individually future use of vitamin D receptor agonists (VDRA), phosphate binders, erythropoiesis stimulating agents (ESAs) and iron were identified using logistic regression in a prospective cohort study containing demography, comorbidity, hospitalization, laboratory, and mortality data in patients with CKD stage G4/G5 across six European countries. Discriminative ability was measured using C-statistics, and predicted probability of medication use used to inform follow-up frequency.
RESULTS: A total of 2196 patients were included in the analysis. During a median follow-up of 735 days 648 initiated hemodialysis and 1548 did not. Combinations of age, diabetes status and iPTH, calcium, hemoglobin and serum albumin levels predicted the use of ESA, iron, phosphate binder or VDRA, with C-statistics of 0.70, 0.64, 0.73 and 0.63 in derivation cohorts respectively. Model performance in validation cohorts were similar. Sixteen percent of patients were predicted to have a likelihood of receiving any of these medications of less than 20%.
CONCLUSIONS: In a multi-country CKD cohort, prediction of ESA and phosphate binder use over a two-year period can be made based on patient characteristics with the potential to reduce frequency of follow-up in individuals with low risk for requiring these medications.