Static and Dynamic Prediction of Chronic Renal Disease Progression Using Longitudinal Clinical Data from Taiwan's National Prevention Programs.

Yi-Ping Chang,Chih-Ming Lin,Hsiu-Hua Hu,Li-Hsin Wang,Chen-Mao Liao

doi:10.3390/jcm10143085

Yi-Ping Chang, Chih-Ming Lin + Show 3 more

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https://doi.org/10.3390/jcm10143085

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Abstract

Kidney diseases can cause severe morbidity, mortality, and health burden. Determining the risk factors associated with kidney damage and deterioration has become a priority for the prevention and treatment of kidney disease. This study followed 1042 chronic kidney disease (CKD) patients with Stage 3–5 kidney disease who were treated at a public veteran’s hospital through the national prevention program. A total of 12.5 years of records of clinical measurements were collected and analyzed using dynamic and static Cox hazard models to predict the progression to dialysis treatment. The results showed that the statistical significance of several variables in patients with Stage 3–5 CKD was attenuated while the dynamic model was being used. The estimated glomerular filtration rate (eGFR) and urine protein to creatinine ratio (PCR) had the powerful ability to predict the progression of CKD patients with Stage 3a and Stage 3b–5 kidney disease, whereas serum calcium was also predictive for the progression of Stages 3b–5 CKD. Because these two sub-stages of Stage 3 CKD are often associated with differences in routine measurements and the risk analysis of renal dialysis, future research can use this predictive model as a reference while similar prevention programs are implemented.

Highlights

Kidney disease has been ranked among the top 10 causes of death in Taiwan since 1990.There were 5096 deaths due to nephritis, nephrotic syndrome, and nephrosis in 2020, which resulted in a mortality rate of 21.6 per 100,000 [1]
After excluding 24 patients with records missing variables that were missing greater than 30% of values, the study included 1042 patients with Stage 3 to 5 chronic kidney disease (CKD) who were included in the final analysis
We found that the risk factors for the increased progression to dialysis treatment identified using the baseline CKD stage included reduced age, reduced estimated glomerular filtration rate (eGFR), Hgb, serum ALB, serum Na, and serum Ca, as well as increased serum Cr, blood urea nitrogen (BUN), serum P, TG, urine protein to creatinine ratio (PCR), and HbA1c level

Summary

Introduction

Kidney disease has been ranked among the top 10 causes of death in Taiwan since 1990.There were 5096 deaths due to nephritis, nephrotic syndrome, and nephrosis in 2020, which resulted in a mortality rate of 21.6 per 100,000 [1]. Kidney disease has been ranked among the top 10 causes of death in Taiwan since 1990. According to a database maintained by a large standard medical screening program, the prevalence of chronic kidney disease (CKD) in Taiwan is 11.9%, and the increase in end-stage renal disease (ESRD) has been associated with an increase in the incidence of diabetic nephropathy [2]. Taiwan has a lower prevalence rate of CKD than the United States (15%) [3] and Japan (13%) [4], the ESRD rate is higher in Taiwan than in those other countries. States Registration Data System (USRDS), the prevalence rate of ESRD in Taiwan was 3587 per million people in 2018, ranking first in the world [5].

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