Individual patient variability with the application of the kidney failure risk equation in advanced chronic kidney disease.
Individual patient variability with the application of the kidney failure risk equation in advanced chronic kidney disease.
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DOI：
10.1371/journal.pone.0198456
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Sood MM
中科院分区：
文献类型：
--
作者：
McCudden C;Akbari A;White CA;Biyani M;Hiremath S;Brown PA;Tangri N;Brimble S;Knoll G;Blake PG;Sood MM
肾衰竭风险方程 (KFRE) 使用年龄、性别、估计肾小球滤过率 (eGFR) 和尿白蛋白与肌酐比 (ACR) 来预测透析或移植的需要。 eGFR 和 ACR 具有已知的生物学和分析变异性。我们使用模拟 eGFR 和 ACR 的单一测量值和重复测量值的平均值，研究了 eGFR 和 ACR 的生物学和分析变异性对 2 年 KFRE 预测肾衰竭概率的影响。之前报告的 ACR 和 eGFR 变异系数 (CV) 值用于计算每日变异性。还使用 eGFR 在 15 至 50 mL/min/1.72 m2 之间的患者的门诊实验室数据检查了变异。开发了一个网络应用程序来计算和建模风险的日常变化。与 ACR 和 eGFR 相关的生物学和分析变异性导致肾衰竭预测概率的变化。一名 50 岁男性患者，ACR 30 mg/mmol 和 eGFR 25，每天的风险变化为 7%（KFRE 点估计值：17%，变化范围为 14% 至 21%）。由于不同仪器而增加的实验室间变异将变异性增加到 9%（KFRE 点估计为 17%，变异性范围为 13% 至 22%）。 eGFR 和 ACR 重复测量的平均值显着降低了变异性（KFRE 点估计值为 17%，变异性范围为 15% 至 19%）。当使用门诊实验室数据时，这些发现是一致的，表明大多数患者的 KFRE 2 年风险变异性≤ 5%（79% 的患者）。大约 13% 的患者变异性在 5-10% 之间，8% 的患者变异性 > 10%。该队列的平均年龄 (SD) 为 64 (15) 岁，36% 为女性，平均 (SD) eGFR 为 32 (10) ml/min/1.73m2，中位 (IQR) ACR 为 22.7 (110)。 eGFR 和 ACR 固有的生物学和分析变异可能会导致很大程度的变异性，这种变异性会随着重复测量而降低。使用网络应用程序可以帮助医生和患者了解患者个体的风险变异性并沟通风险 (https://mccudden.shinyapps.io/kfre_app/)。该网络应用程序允许用户更改年龄、性别、eGFR、ACR、CV（eGFR 和 ACR）以及 ACR 的测量单位（g/mol 与 mg/g）。
The Kidney Failure Risk Equation (KFRE) predicts the need for dialysis or transplantation using age, sex, estimated glomerular filtration rate (eGFR), and urine albumin to creatinine ratio (ACR). The eGFR and ACR have known biological and analytical variability. We examined the effect of biological and analytical variability of eGFR and ACR on the 2-year KFRE predicted kidney failure probabilities using single measure and the average of repeat measures of simulated eGFR and ACR. Previously reported values for coefficient of variation (CV) for ACR and eGFR were used to calculate day to day variability. Variation was also examined with outpatient laboratory data from patients with an eGFR between 15 and 50 mL/min/1.72 m2. A web application was developed to calculate and model day to day variation in risk. The biological and analytical variability related to ACR and eGFR lead to variation in the predicted probability of kidney failure. A male patient age 50, ACR 30 mg/mmol and eGFR 25, had a day to day variation in risk of 7% (KFRE point estimate: 17%, variability range 14% to 21%). The addition of inter laboratory variation due to different instrumentation increased the variability to 9% (KFRE point estimate 17%, variability range 13% to 22%). Averaging of repeated measures of eGFR and ACR significantly decreased the variability (KFRE point estimate 17%, variability range 15% to 19%). These findings were consistent when using outpatient laboratory data which showed that most patients had a KFRE 2-year risk variability of ≤ 5% (79% of patients). Approximately 13% of patients had variability from 5–10% and 8% had variability > 10%. The mean age (SD) of this cohort was 64 (15) years, 36% were females, the mean (SD) eGFR was 32 (10) ml/min/1.73m2 and median (IQR) ACR was 22.7 (110). Biological and analytical variation intrinsic to the eGFR and ACR may lead to a substantial degree of variability that decreases with repeat measures. Use of a web application may help physicians and patients understand individual patient’s risk variability and communicate risk (https://mccudden.shinyapps.io/kfre_app/). The web application allows the user to alter age, gender, eGFR, ACR, CV (for both eGFR and ACR) as well as units of measurements for ACR (g/mol versus mg/g).
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DOI：
10.2215/cjn.05400516
发表时间：
2017-01-01
影响因子：
9.8
作者：
Lee, Elizabeth;Collier, Christine P.;White, Christine A.
通讯作者：
White, Christine A.
影响因子：
37.8
作者：
Wilson, PWF;D'Agostino, RB;Kannel, WB
通讯作者：
Kannel, WB
DOI：
10.1053/j.ajkd.2012.11.048
发表时间：
2013-05
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Selvin E;Juraschek SP;Eckfeldt J;Levey AS;Inker LA;Coresh J
通讯作者：
Coresh J
跨国评估方程的准确性预测肾衰竭风险：一项荟萃分析。
DOI：
10.1001/jama.2015.18202
发表时间：
2016-01-12
期刊：
JAMA
影响因子：
--
作者：
Tangri N;Grams ME;Levey AS;Coresh J;Appel LJ;Astor BC;Chodick G;Collins AJ;Djurdjev O;Elley CR;Evans M;Garg AX;Hallan SI;Inker LA;Ito S;Jee SH;Kovesdy CP;Kronenberg F;Heerspink HJ;Marks A;Nadkarni GN;Navaneethan SD;Nelson RG;Titze S;Sarnak MJ;Stengel B;Woodward M;Iseki K;CKD Prognosis Consortium
通讯作者：
CKD Prognosis Consortium
影响因子：
1.7
作者：
Sontrop JM;Garg AX;Li L;Gallo K;Schumann V;Winick-Ng J;Clark WF;Weir MA
通讯作者：
Weir MA