Predicting 5-Year Risk of RRT in Stage 3 or 4 CKD: Development and External Validation

Schroeder, Emily B.; Yang, Xiuhai; Thorp, Micah L.; Arnold, Brent M.; Tabano, David; Petrik, Amanda F.; Smith, David H.; Platt, Robert W.; Johnson, Eric S.

doi:10.2215/cjn.01290216

Cited by 52 publications

(57 citation statements)

References 34 publications

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“…Hence, there is growing interest in developing ways to detect progressive disease in order to guide optimal management. Novel biomarkers [4] and risk prediction models based on multiple clinical parameters [5,6] are being pursued.…”

Section: Introductionmentioning

confidence: 99%

Cortical Perfusion and Tubular Function as Evaluated by Magnetic Resonance Imaging Correlates with Annual Loss in Renal Function in Moderate Chronic Kidney Disease

Prasad

Thacker

et al. 2019

Am J Nephrol

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Background: Chronic hypoxia is a well-recognized factor in the pathogenesis of chronic kidney disease (CKD). Loss of microcirculation is thought to lead to enhanced renal hypoxia, which in turn results in the development of fibrosis, a hallmark of progressive CKD. To evaluate the role of functional magnetic resonance imaging (MRI), we performed perfusion, oxygenation, and diffusion MRI measurements in individuals with diabetes and stage 3 CKD. Methods: Fifty-four subjects (41 individuals with diabetes and stage 3 CKD and 13 healthy controls) participated in this study. Data with blood oxygenation level dependent (BOLD), arterial spin labeling perfusion and diffusion MRI were acquired using a 3T scanner. Results: Renal cortical perfusion was reduced in CKD compared to the controls (109.54 ± 25.38 vs. 203.17 ± 27.47 mL/min/100 g; p < 0.001). Cortical apparent diffusion coefficient showed no significant reduction in CKD compared to controls (1,596.10 ± 196.64 vs. 1,668.72 ± 77.29 × 10^–6 mm²/s; p = 0.45) but was significantly associated with perfusion. Cortical R2* values were modestly increased in CKD (20.76 ± 4.08 vs. 18.74 ± 2.37 s^–1; p = 0.12). Within the CKD group, R2*_Medulla and R2*_Kidney were moderately and negatively associated with estimated glomerular filtration rate. There was a significant association between cortical perfusion and medullary response to furosemide with annual loss of renal function, used as an estimate of CKD progression. Conclusions: Subjects with a moderate degree of CKD had significantly lower renal perfusion. Diffusion and BOLD MRI showed more modest differences between the groups. Individuals with progressive CKD had lower perfusion and response to furosemide.

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Section: Introductionmentioning

confidence: 99%

Cortical Perfusion and Tubular Function as Evaluated by Magnetic Resonance Imaging Correlates with Annual Loss in Renal Function in Moderate Chronic Kidney Disease

Prasad

Thacker

et al. 2019

Am J Nephrol

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“…All these activities are known to slow disease progression and therefore to delay the initiation of RRT [35]. …”

Section: Discussionmentioning

confidence: 99%

NT-proBNP in the Prognosis of Death or Need for Renal Replacement Therapy in Patients with Stage 3–5 Chronic Kidney Disease

Gromadziński

Januszko‐Giergielewicz

Czarnacka³

et al. 2019

Cardiorenal Med

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Background: The risk of cardiovascular (CV) complications is much greater in patients with chronic kidney disease (CKD). The aim of this study was to assess predictors of mortality, renal failure progression, and the need for dialysis in patients with CKD. Methods: The study group consisted of 70 patients with stage 3–5 CKD, followed up on average for 33.4 ± 15.6 months. Laboratory tests and echocardiography were performed on all patients. Composite endpoints were defined as (1) all-cause mortality and (2) mortality or renal replacement therapy (RRT), defined as the initiation of dialysis therapy. Results: During the observation period, 13 patients died and 11 began dialysis therapy. NT-proBNP was found to be a significant predictor in receiver operating characteristic curve analysis for all study endpoints. The optimal cutoff value for NT-proBNP as a predictor of mortality was 569.8 pg/mL, with a sensitivity of 53.8% and a specificity of 89.1%. For mortality or RRT, the cutoff value for NT-proBNP was 384.9 pg/mL, with a sensitivity and specificity of 70.8 and 72.7%, respectively. In a multivariate regression analysis, NT-proBNP was an independent predictor of mortality with an OR = 7.5 (95% CI: 1.05–53.87; p = 0.044) and of mortality or RRT with an OR = 4.7 (95% CI: 1.01–22.66; p = 0.048). Conclusions: NT-proBNP is an independent predictor of mortality in patients with CKD and can also be useful for CV risk stratification in this patient population.

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“…The study by Schroeder et al (8) provides several interesting observations. First, the only completely new variable in the current versus previously developed Kaiser Permanente risk equation was albuminuria (although the definitions of diabetes mellitus and hypertension were enhanced).…”

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confidence: 93%

“…kidneyfailurerisk.com). In this issue of the Clinical Journal of the American Society of Nephrology, Schroeder et al (8) propose another kidney failure risk equation developed in 22,460 Kaiser Permanente Northwest patients and validated in 16,553 patients in Colorado. The work, which builds on a previously developed model (5), incorporates age, sex, eGFR, hemoglobin level, the presence of proteinuria or albuminuria, systolic BP, antihypertensive medication use, and a modified Diabetes Complications Severity Index to predict 5-year risk of progression to a requirement for dialysis or kidney transplantation among patients with eGFR,60 ml/min per 1.73 m 2 .…”

mentioning

confidence: 99%

“…The risk equation developed by Schroeder et al (8) showed excellent performance in both discrimination and calibration, and Kaiser Permanente has the benefit of being able to implement an equation that was developed in its own system. Application to external health systems might require calibration, similar to work in non-North American countries, because absolute risks often vary across settings (7,13).…”

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confidence: 99%

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Predicting Risk of RRT in Patients with CKD

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Predicting 5-Year Risk of RRT in Stage 3 or 4 CKD: Development and External Validation

Cited by 52 publications

References 34 publications

Cortical Perfusion and Tubular Function as Evaluated by Magnetic Resonance Imaging Correlates with Annual Loss in Renal Function in Moderate Chronic Kidney Disease

Cortical Perfusion and Tubular Function as Evaluated by Magnetic Resonance Imaging Correlates with Annual Loss in Renal Function in Moderate Chronic Kidney Disease

NT-proBNP in the Prognosis of Death or Need for Renal Replacement Therapy in Patients with Stage 3–5 Chronic Kidney Disease

Predicting Risk of RRT in Patients with CKD

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