External Validation of the Kidney Failure Risk Equation and Re-Calibration with Addition of Ultrasound Parameters
External Validation of the Kidney Failure Risk Equation and Re-Calibration with Addition of Ultrasound Parameters
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DOI：
10.2215/cjn.08110715
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发表时间：
2016-04-01
影响因子：
9.8
通讯作者：
Heine, Gunnar H.
中科院分区：
文献类型：
--
作者：
Lennartz, Claudia S.;Pickering, John William;Heine, Gunnar H.
背景与目的慢性肾脏病向终末期肾病的进展是异质性的。肾功能衰竭风险方程(KFRE)被用来识别具有终末期肾病高危风险的CKD患者。我们的目标是在外部验证KFRE，并测试增加预定义的双工超声标记物-肾脏阻力指数(RRI)或脾和肾脏阻力指数的差异(DI-Risk)-是否改善了终末期肾病的预测。设计、设置、参与者和测量CKD 2-4患者的预期心血管和肾脏结果-第四项Homburg评估(居家护理)研究招募了CKD G2-G4期患者转诊到第三转诊中心进行肾脏逻辑护理。在2008至2012年间登记的403名家庭参与者在纳入研究时有可用的RRI测量；随后他们被跟踪了平均4.4+/-1.6年。该子队列用于验证KFRE并评估超声标记物(新模型KFRE+RRI和KFRE+DI-Risk)的附加值。通过对数似然比检验、c统计量、综合判别改善指标(对于没有后续ESRD的研究参与者[IDI(No ESRD)]和患有ESRD的患者[IDI(ESRD)])和校准曲线图来评估模型的性能。如果两种新模型中的任何一种都比KFRE有所改进，我们决定在162名CKD患者的独立队列中验证它。结果KFRE预测家庭参与者护理中的ESRD的c统计量为0.91(95%可信区间，0.83到0.99)。加入RRI改进了KFRE模型(P
Background and objectives Progression of CKD toward ESRD is heterogeneous. The Kidney Failure Risk Equation (KFRE) was developed to identify CKD patients at high risk of ESRD. We aimed to externally validate KFRE and to test whether the addition of predefined Duplex ultrasound markers - renal resistive index (RRI) or difference of resistive indices in spleen and kidney (DI-RISK) - improved ESRD prediction.Design, setting, participants, & measurements The prospective Cardiovascular and Renal Outcome in CKD 2-4 Patients-The Fourth Homburg evaluation (CARE FOR HOMe) study recruits CKD stage G2-G4 patients referred to a tertiary referral center for nephrologic care. Four hundred three CARE FOR HOMe participants enrolled between 2008 and 2012 had available RRI measurements at study inclusion; they were subsequently followed for a mean of 4.4 +/- 1.6 years. This subcohort was used to validate KFRE and to assess the added value of the ultrasound markers (new models KFRE+RRI and KFRE+DI-RISK). Model performance was assessed by log-likelihood ratio test, c-statistic, integrated discrimination improvement metrics (for study participants without subsequent ESRD [IDI (No ESRD)] and for patients with ESRD [IDI (ESRD)]), and calibration plots. If either new model improved on KFRE, we determined to validate it in an independent cohort of 162 CKD patients.Results KFRE predicted ESRD in CARE FOR HOMe participants with a c-statistic of 0.91 (95% confidence interval, 0.83 to 0.99). Adding RRI improved the KFRE model (P