Objectives The positive predictive value (PPV) of a single assessment of estimated glomerular filtration rate (eGFR) in the diagnosis of chronic kidney disease (CKD) is not known. Our objective was to determine the PPV of a single assessment of eGFR among adults with at least one eGFR <60 mL/min in their lifetime, using the Distributed Area Research and Therapeutics Network CKD natural history dataset. Methods In all, 47,104 adults who were cared for by 113 practices in the United States were included. Proportions of patients in eGFR categories at baseline were calculated using the following categories: <15 mL/min, 15 to 29.99 mL/min, 30 to 44.99 mL/min, and 45 to 59.99 mL/min. Comparisons were then made between the baseline and the endpoint to identify patients who had a follow-up eGFR that remained at <60 mL/min. The proportions of patients in each eGFR category were compared baseline to endpoint using cross-tabulations. To test the proposed cutpoint, the proportions of patients who had an eGFR that remained at <60 mL/min were measured, using the cutpoints that included the highest cumulative proportion of patients. The sensitivity and specificity of that cutpoint were calculated. Results A cutpoint of <45 mL/min was identified, yielding a PPV of 93% with a sensitivity of 28% and a specificity of 94%. Conclusions A valid cutpoint to screen for CKD was identified. This cutpoint may prove important to early screening for CKD while reducing the burden on the healthcare system and patients suspected of having CKD.
The rate of micrometastatic disease (MMD) to nonsentinel lymph nodes (NSLNs) has been shown to vary considerably in the literature. We identified patients with breast cancer with MMD (N1mi) and measured the incidence of NSLN involvement. We then compared these patients with those who had no metastasis to the SLN (N0) and those who had macrometastasis to the SLN (N2) in an attempt to better understand the behavior of patients with N1mi positivity. A retrospective analysis was conducted on 574 patients with invasive breast cancer between January 2000 and December 2007. Patients were stratified into three groups: no metastasis (N0), MMD (N1mi), and macrometastasis (N2). Chi square analysis and logistic regression models using SPSS software were applied to determine significance between groups. MMD rate was 7.7 per cent (44 of 574). Of this subset of patients, 33 underwent completion axillary dissection, and only two were found to have NSLN-positive disease. Statistical significance was achieved for NSLN positivity when comparing all three nodal groups against one another (χ22,572 = 337.084, P = 0.000). Logistic regression showed multifocality and lymphovascular invasion to be significant predictors of NSLN metastasis. NSLN positivity in patients with MMD acts similarly to node-positive disease and therefore cannot completely exclude axillary dissection from therapeutic algorithm.
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