Multinational Assessment of Accuracy of Equations for Predicting Risk of Kidney Failure: A Meta-analysis.
Multinational Assessment of Accuracy of Equations for Predicting Risk of Kidney Failure: A Meta-analysis.
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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
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发表时间：
2016-01-12
期刊：
影响因子：
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通讯作者：
CKD Prognosis Consortium
中科院分区：
文献类型：
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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
确定有慢性肾脏疾病(CKD)进展风险的患者可能有助于更理想的肾脏护理。肾功能衰竭风险方程(KFRE)先前已在两个加拿大队列中开发和验证。需要在其他地区和不在肾病学家护理下的CKD人群中进行验证。通过个体-参与者数据荟萃分析，评估不同地理区域和患者群体KFRE的准确性。对31个队列进行了研究，其中包括来自四大洲30多个国家的721,357名CKD 3-5期参与者。这些队列收集了从1982年到2014年的数据。参与CKD预后联盟的队列和终末期肾脏疾病的数据。在2012年7月至2015年6月期间获得了数据并进行了统计分析。使用来自原始KFREs的风险因素，估计特定于队列的危险比，并在荟萃分析中结合形成新的“集合”KFREs。比较了原始方程和合并方程的性能，并评估了区域校准因子的必要性。肾衰竭(透析或肾移植治疗)。在中位数4年的随访中，观察到23,829例肾功能衰竭。最初的KFRE在所有队列(总体C统计，2年时为0.90(95%可信区间0.89-0.92)和5年时为0.88(95%可信区间0.86-0.90))中获得了出色的辨别力(区分发生肾衰竭的人和未发生肾衰竭的人的能力)；按年龄、种族和糖尿病状况在亚组中的区分类似。合并后的方程没有任何改进。校准(观察到的风险和预测的风险之间的差异)在北美队列中是足够的，但最初的KFRE高估了一些非北美队列中的风险。添加一个校正因子，在2年和5年分别将基线风险降低32.9%和16.5%，分别在12/15和10/13非北美队列中改善了2年和5年的校正(p=0.04和p=0.02)。在加拿大人群中开发的KFRE在31个多国队列中得到验证时，显示出高度的区分性和充分的校准。然而，在某些地区，可能需要增加一个校准系数。
Identifying patients at risk of chronic kidney disease (CKD) progression may facilitate more optimal nephrology care. Kidney failure risk equations (KFREs) were previously developed and validated in two 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 KFREs across different geographic regions and patient populations through individual-participant data meta-analysis. Thirty-one cohorts, including 721,357 participants with CKD Stages 3–5 in over 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 KFREs, cohort-specific hazard ratios were estimated, and combined in meta-analysis to form new “pooled” KFREs. Original and pooled equation performance was compared, and the need for regional calibration factors was assessed. Kidney failure (treatment by dialysis or kidney transplantation). During a median follow-up of 4 years, 23,829 cases of kidney failure were observed. The original KFREs 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 and 0.88 (95% CI 0.86–0.90) at 5 years); 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 KFREs 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 12/15 and 10/13 non-North American cohorts at 2 and 5 years, respectively (p=0.04 and p=0.02). KFREs 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.