Patients,’ Nephrologists,’ and Predicted Estimations of ESKD Risk Compared with 2-Year Incidence of ESKD

Abstract

Background and objectives The rate of progression to ESKD is variable, and prognostic information helps patients and physicians plan for future ESKD. We assessed the estimations of ESKD risk of patients with CKD and physicians and compared them with risk calculators and outcomes at 2 years. Design, setting, participants, & measurements This prospective observational study assessed 257 adult patients with CKD stages 3-5 and their nephrologists at University of California, San Diego and Veterans Affairs San Diego CKD clinics. Patients' and nephrologists' estimations of 2-year ESKD risk were evaluated, and objective estimation of 2-year risk was determined using kidney failure risk equations; actual incidence rates of ESKD and death were ascertained by chart review. Participants' baseline characteristics were compared across kidney failure risk equation risk levels and according to whether patients' estimations were more optimistic or pessimistic than physicians' estimations. We examined correlations between estimations and compared estimations with outcomes using c statistics and calibration plots. Results Average age was 65 (613) years old, and eGFR was 34 (613) ml/min per 1.73 m 2. Overall, 13% reached ESKD, and 9% died. About one quarter of patients gave estimates that were .20% more optimistic than physicians, and more than one in ten gave estimates that were .20% more pessimistic. Physicians' and kidney failure risk equation estimations had the strongest correlation (r=0.72; P,0.001) compared with 0.50 (P,0.001) between physicians and patients and 0.47 (P,0.001) between patients and kidney failure risk equation. Although all three estimations provided reasonable risk rankings (c statistics .0.8), physicians and patients overestimated risk compared with actual outcomes; no patient whose physician estimated a risk of ESKD ,15% reached ESKD at 2 years. The kidney failure risk equation was best calibrated to actual ESKD risk. Conclusions Compared with actual ESKD incidence, the kidney failure risk equation outperformed patients' and physicians' estimations of ESKD incidence. Patients and physicians overestimated risk compared with the kidney failure risk equation.

A validation study of the kidney failure risk equation in advanced chronic kidney disease according to disease aetiology with evaluation of discrimination, calibration and clinical utility

“…Communicating risk to patients is important as it provides an avenue to engage, counsel and potentially modify behaviour for patients at high-risk. Using the KFRE has been shown to be far more accurate than subjectively determining patients’ risk: in a prospective study of 257 patients with CKD stages 3–5, the KFRE better matched 2-year outcomes of ESRD than the predicted estimates from nephrologists and patients, who both tended to overestimate risk [ 19 ].…”

Medical Record Documentation of Goals-of-Care Discussions Among Older Veterans With Incident Kidney Failure

“…This finding may indicate that uncertainty over whether patients will survive to reach kidney failure causes delay of supportive-care discussions until dialysis is imminent. 24 Uncertainty around the rate of progression to kidney failure may also play a role; patients who experience rapid progression of chronic kidney disease or acute kidney injury superimposed on chronic kidney disease have a compressed time frame for eliciting and documenting goals of care.…”

Risikoscores für chronisch nierenkranke Menschen

“…Kalibrierungsfaktor eingeführt. Eine kleinere Studie konnte darüber hinaus zeigen, dass die Tangri-Formel in der Vorhersage des terminalen Nierenversagens sowohl der Einschätzung des Patienten selbst als auch der Einschätzung des Arztes überlegen, d. h. präziser als diese beiden, ist [6]. Sowohl die Patienten als auch die behandelnden Ärzte tendierten interessanterweise dazu, das Risiko für eine Terminalisierung der Nierenfunktion zu überschätzen.…”