The Kidney Failure Risk Equation for prediction of end stage renal disease in UK primary care: An external validation and clinical impact projection cohort study
The Kidney Failure Risk Equation for prediction of end stage renal disease in UK primary care: An external validation and clinical impact projection cohort study
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DOI：
10.1371/journal.pmed.1002955
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发表时间：
2019-11-01
期刊：
影响因子：
15.8
通讯作者：
Brunskill, Nigel J.
中科院分区：
文献类型：
--
作者：
Major, Rupert W.;Shepherd, David;Brunskill, Nigel J.
肾衰竭风险方程（KFRE）使用慢性肾脏病（CKD）患者的年龄、性别、尿白蛋白/肌酐比值（ACR）和估计肾小球滤过率（eGFR）4个变量来预测终末期肾脏病（ESRD）的风险，即，需要透析或肾移植，在2年和5年内。目前，英国和其他国家的国家指南作者正在评估KFRE在从初级保健到二级保健的肾脏转诊中的作用，但KFRE在初级保健中的外部验证有限。因此，本研究的目的是外部验证KFRE对初级保健中ESRD事件的预测，必要时进行模型重新校准，并评估其对二级保健肾脏服务转诊率的预计影响。方法和结果队列中包括2个或多个慢性肾脏病流行病学协作组（CKD-EPI）eGFR值< 60 ml/min/1.73 m（2），间隔超过90天，并且在2004年12月1日至2016年11月1日期间进行尿ACR或蛋白质与肌酐比值测量的个体。该队列包括35，539（5.6%）名个体（57.5%为女性，平均年龄75.9岁，中位CKD-EPI eGFR 51 ml/min/1.73 m（2），中位ACR 3.2 mg/mmol），来自630，504名成人实践人群。总体而言，2年和5年内分别发生了176例（0.50%）和429例（1.21%）ESRD事件。中位随访时间为4.7年（IQR 2.8至6.6）。2年（C-统计量0.932，95% CI 0.909 - 0.954）和5年（C-统计量0.924，95% CI 0.909 - 0.938）ESRD预测的模型区分度均极佳。KFRE高估了低风险（
Background The Kidney Failure Risk Equation (KFRE) uses the 4 variables of age, sex, urine albumin-to-creatinine ratio (ACR), and estimated glomerular filtration rate (eGFR) in individuals with chronic kidney disease (CKD) to predict the risk of end stage renal disease (ESRD), i.e., the need for dialysis or a kidney transplant, within 2 and 5 years. Currently, national guideline writers in the UK and other countries are evaluating the role of the KFRE in renal referrals from primary care to secondary care, but the KFRE has had limited external validation in primary care. The study's objectives were therefore to externally validate the KFRE's prediction of ESRD events in primary care, perform model recalibration if necessary, and assess its projected impact on referral rates to secondary care renal services. Methods and findings Individuals with 2 or more Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) eGFR values < 60 ml/min/1.73 m(2) more than 90 days apart and a urine ACR or protein-to-creatinine ratio measurement between 1 December 2004 and 1 November 2016 were included in the cohort. The cohort included 35,539 (5.6%) individuals (57.5% female, mean age 75.9 years, median CKD-EPI eGFR 51 ml/min/1.73 m(2), median ACR 3.2 mg/mmol) from a total adult practice population of 630,504. Overall, 176 (0.50%) and 429 (1.21%) ESRD events occurred within 2 and 5 years, respectively. Median length of follow-up was 4.7 years (IQR 2.8 to 6.6). Model discrimination was excellent for both 2-year (C-statistic 0.932, 95% CI 0.909 to 0.954) and 5-year (C-statistic 0.924, 95% 0.909 to 0.938) ESRD prediction. The KFRE overpredicted risk in lower (