Low performance of prognostic tools for predicting dialysis in elderly people with advanced CKD

Prouvot, Julien; Pambrun, Emilie; Couchoud, Cécile; Vigneau, Cécile; Roche, Sophie; Allot, Vincent; Potier, Jérôme; François, Maud; Babici, Daniela; Prelipcean, Camelia; Moranne, Olivier

doi:10.1007/s40620-020-00919-6

Cited by 7 publications

(8 citation statements)

References 55 publications

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“…2, 3, 4, 5, 19, 20, 25, 26, 30, 33) than the ones they were developed for. Three PTs had poor discriminatory power in these patient populations (no.2, 30, 33), with C-statistics between 0.5 and 0.6 63 66. Performance metrics were generally comparable between developmental and external validation studies when similar patient populations were used (see tables 1 and 2).…”

Section: Resultsmentioning

confidence: 82%

“…Table 2 provides an overview of the PTs (no. 2–5, 19, 20, 25, 26, 30, 33, 51, 52) that were externally validated in independent external validation studies 31 32 46 55 60–69. Table S2 in online supplemental appendix 4 provides additional details on these external validation studies.…”

Section: Resultsmentioning

confidence: 99%

“…One PT (no. 2) was externally validated in six different studies,32 60–63 67 two other PTs (no. 3, 25) were externally validated in three31 62 67 and four different studies,46 55 64 66 respectively.…”

Section: Resultsmentioning

confidence: 99%

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Shared decision-making in advanced kidney disease: a scoping review

et al. 2022

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ObjectivesTo provide a comprehensive overview of interventions that support shared decision-making (SDM) for treatment modality decisions in advanced kidney disease (AKD). To provide summarised information on their content, use and reported results. To provide an overview of interventions currently under development or investigation.DesignThe JBI methodology for scoping reviews was followed. This review conforms to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist.Data sourcesMEDLINE, Embase, Web of Science, Cochrane Library, Emcare, PsycINFO, PROSPERO and Academic Search Premier for peer-reviewed literature. Other online databases (eg, clinicaltrials.gov, OpenGrey) for grey literature.Eligibility for inclusionRecords in English with a study population of patients >18 years of age with an estimated glomerular filtration rate <30 mL/min/1.73 m2. Records had to be on the subject of SDM, or explicitly mention that the intervention reported on could be used to support SDM for treatment modality decisions in AKD.Data extraction and synthesisTwo reviewers independently screened and selected records for data extraction. Interventions were categorised as prognostic tools (PTs), educational programmes (EPs), patient decision aids (PtDAs) or multicomponent initiatives (MIs). Interventions were subsequently categorised based on the decisions they were developed to support.ResultsOne hundred forty-five interventions were identified in a total of 158 included records: 52 PTs, 51 EPs, 29 PtDAs and 13 MIs. Sixteen (n=16, 11%) were novel interventions currently under investigation. Forty-six (n=46, 35.7%) were reported to have been implemented in clinical practice. Sixty-seven (n=67, 51.9%) were evaluated for their effects on outcomes in the intended users.ConclusionThere is no conclusive evidence on which intervention is the most efficacious in supporting SDM for treatment modality decisions in AKD. There is a lot of variation in selected outcomes, and the body of evidence is largely based on observational research. In addition, the effects of these interventions on SDM are under-reported.

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Section: Resultsmentioning

confidence: 82%

Section: Resultsmentioning

confidence: 99%

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Shared decision-making in advanced kidney disease: a scoping review

et al. 2022

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“…(37) In previous French validation studies the Grams model was externally validated in a cohort of advanced CKD patients aged 75 years and older for the outcomes KRT and 'death without KRT'. (7,8) These studies reported a C-statistic of 0.64 and 0.65 for KRT and a Cstatistic of 0.68 and 0.70 for 'death without KRT' for the 2 and 4 year models, respectively. Our decision curve analysis showed that for most patients, using individualized risk thresholds has a higher potential clinical utility than using eGFR thresholds, though the eGFR<15 guideline also showed good performance.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, the Grams model has only been externally validated for the outcome KRT and death before dialysis and has yet to be validated for cardiovascular disease (CVD) and overall death. 4 , 7 , 8 Before use, external validation of prediction models is crucial in order to determine the accuracy in new patients.…”

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confidence: 99%