Abstract
Patients with chronic kidney disease and severely decreased glomerular filtration rate (GFR) are at high risk for kidney failure, cardiovascular disease (CVD) and death. Accurate estimates of risk and timing of these clinical outcomes could guide patient counseling and therapy. Therefore, we developed models using data of 264,296 individuals in 30 countries participating in the international Chronic Kidney Disease Prognosis Consortium with estimated GFR (eGFR)s under 30 ml/min/1.73m2. Median participant eGFR and urine albumin-to-creatinine ratio were 24 ml/min/1.73m2 and 168 mg/g, respectively. Using competing-risk regression, random-effect meta-analysis, and Markov processes with Monte Carlo simulations, we developed two- and four-year models of the probability and timing of kidney failure requiring kidney replacement therapy (KRT), a non-fatal CVD event, and death according to age, sex, race, eGFR, albumin-to-creatinine ratio, systolic blood pressure, smoking status, diabetes mellitus, and history of CVD. Hypothetically applied to a 60-year-old white male with a history of CVD, a systolic blood pressure of 140 mmHg, an eGFR of 25 ml/min/1.73m2 and a urine albumin-to-creatinine ratio of 1000 mg/g, the four-year model predicted a 17% chance of survival after KRT, a 17% chance of survival after a CVD event, a 4% chance of survival after both, and a 28% chance of death (9% as a first event, and 19% after another CVD event or KRT). Risk predictions for KRT showed good overall agreement with the published kidney failure risk equation, and both models were well calibrated with observed risk. Thus, commonly-measured clinical characteristics can predict the timing and occurrence of clinical outcomes in patients with severely decreased GFR.
| Original language | English |
|---|---|
| Pages (from-to) | 1442-1451 |
| Number of pages | 10 |
| Journal | Kidney International |
| Volume | 93 |
| Issue number | 6 |
| Early online date | 29 Mar 2018 |
| DOIs | |
| Publication status | Published - Jun 2018 |
Bibliographical note
This project was funded by the Kidney Disease: Improving Global Outcomes Foundation. The CKD-PC Data Coordinating Center is funded in part by a program grant from the US National Kidney Foundation, the Kidney Disease: Improving Global Outcomes Foundation, and the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100446-01). A variety of sources have supported enrollment and data collection, including laboratory measurements and follow-up in the collaborating cohorts of the CKD-PC. These funding sources include government agencies such as national institutes of health and medical research councils, as well as foundations and industry sponsors listed in Appendix S3. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.Some of the data reported here have been supplied by the United States Renal Data System. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US government.
Funding
JJC received consulting fees from Astellas, lecture fees from Abbott, and grant support from AstraZeneca and ViforPharma donated to Karolinska Institutet. HJLH received consulting fees from Abbvie, AstraZeneca, Boehringer Ingelheim, Fresenius, Janssen, and Merck; lecture fees from AstraZeneca and Boehringer Ingelheim; and grant support from AstraZeneca and Boehringer Ingelheim. KH received lecture fees and is under negotiation for grant funding from Sanofi-Genzyme and has royalties from Partner's Healthcare patent #5,356,775. SDN received grant support from the National Institutes of Health. BS received consulting fees from Merck Sharp & Dohme and grant support from Amgen, Baxter, Lilly, Fresenius, GlaxoSmithKline, Merck Sharp & Dohme, and Otsuka. AY-MW received lecture fees from Sanofi and travel support from Sanofi and Fresenius Medical Care. AK received grant support from AstraZeneca. ASL received grant support from the National Kidney Foundation, National Institutes of Health, AstraZeneca, and Pharmalink, and holds a provisional patent along with JC (JC, Lesley Inker, and ASL) filed August 15, 2014 –“Precise estimation of glomerular filtration rate from multiple biomarkers” PCT/US2015/044567. The technology is not licensed in whole or in part to any company. Tufts Medical Center, John Hopkins University, and Metabolon Inc. have a collaboration agreement to develop a product to estimate glomerular filtration rate from a panel of markers. MW received consulting fees from Amgen. JC received grant support from the National Institutes of Health and National Kidney Foundation. All the other authors declared no competing interests. This project was funded by the Kidney Disease: Improving Global Outcomes Foundation. The CKD-PC Data Coordinating Center is funded in part by a program grant from the US National Kidney Foundation, the Kidney Disease: Improving Global Outcomes Foundation, and the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100446-01). A variety of sources have supported enrollment and data collection, including laboratory measurements and follow-up in the collaborating cohorts of the CKD-PC. These funding sources include government agencies such as national institutes of health and medical research councils, as well as foundations and industry sponsors listed in Appendix S3 . The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Some of the data reported here have been supplied by the United States Renal Data System. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US government.
Keywords
- albuminuria
- cardiovascular disease
- chronic kidney disease
Access to Document
- Accepted Manuscript
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