An independent validation of the kidney failure risk equation in an Asian population

Min Woo Kang,Navdeep Tangri,Yon Su Kim,Yun Kyu Oh,Jung Pyo Lee,Jung Nam An,Jeonghwan Lee,Yong Chul Kim,Chun Soo Lim,Kwon Wook Joo,Lilin Li,Dong Ki Kim

doi:10.1038/s41598-020-69715-3

Abstract

Predicting the risk of end-stage renal disease (ESRD) progression facilitates appropriate nephrology care of patients with chronic kidney disease (CKD). Previously, the kidney failure risk equations (KFREs) were developed and validated in several cohorts. The purpose of this study is to validate the KFREs in a Korean population and to recalibrate the equations. A total of 38,905 adult patients, including 13,244 patients with CKD stages G3–G5, who were referred to nephrology were recruited. Using the original KFREs (4-, 6- and 8-variable equations) and recalibration equations, we predicted the risk of 2- and 5-year ESRD progression. All analyses were conducted in CKD stages G3-G5 patients as well as the total population. In CKD stages G3–G5 patients, All the original 4-, 6- and 8-variable equations showed excellent areas under the receiver operating characteristic curve of 0.87 and 0.83 for the 2- and 5-year risk of ESRD, respectively. The results of net reclassification improvement, integrated discrimination index and Brier score showed that recalibration improved the prediction models in some cases. The original KFREs showed high discrimination in both CKD stages G3–G5 patients and the total population referred to nephrology in this large Korean cohort. KFREs can be implemented in Korean health systems and can guide nephrology referrals and other CKD-related treatment decisions.

Highlights

IntroductionCharacteristics Age (years) Male (%) HTN (%) DM (%) GFR (mL/min/1.73 m 2) Urine albumin-to-creatinine ratio (mg/g) Serum calcium (mg/dL) Serum phosphate (mg/dL) Serum albumin (g/dL) Serum total CO2 (mmol/L) Development of end-stage renal disease (ESRD) (%) Observational time (years) glomerular filtration rate (eGFR) is the primary criteria used to guide nephrology referrals in Korea[15,16,17]
Characteristics Age Male (%) HTN (%) DM (%) GFR Urine albumin-to-creatinine ratio Serum calcium Serum phosphate Serum albumin (g/dL) Serum total CO2 Development of end-stage renal disease (ESRD) (%) Observational time glomerular filtration rate is the primary criteria used to guide nephrology referrals in Korea[15,16,17]
To identify whether the eGFR is better or worse than the KFREs when determining the referral to nephrology, we evaluated the performance of KFREs in the total population followed up at nephrology, including non-chronic kidney disease (CKD) patients, and compared KFREs with the eGFR as the predictor of progression to ESRD

Summary

Introduction

Characteristics Age (years) Male (%) HTN (%) DM (%) GFR (mL/min/1.73 m 2) Urine albumin-to-creatinine ratio (mg/g) Serum calcium (mg/dL) Serum phosphate (mg/dL) Serum albumin (g/dL) Serum total CO2 (mmol/L) Development of ESRD (%) Observational time (years) glomerular filtration rate (eGFR) is the primary criteria used to guide nephrology referrals in Korea[15,16,17]. To identify whether the eGFR is better or worse than the KFREs when determining the referral to nephrology, we evaluated the performance of KFREs in the total population followed up at nephrology, including non-CKD patients, and compared KFREs with the eGFR as the predictor of progression to ESRD

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