A Validation Study Comparing Risk Prediction Models of IgA Nephropathy

Abstract

We aimed to validate three IgAN risk models proposed by an international collaborative study and another CKD risk model generated by an extended CKD cohort with our multicenter Chinese IgAN cohort. Biopsy-proven IgAN patients with an eGFR ≥15 ml/min/1.73 m2 at baseline and a minimum follow-up of 6 months were enrolled. The primary outcomes were a composite outcome (50% decline in eGFR or ESRD) and ESRD. The performance of those models was assessed using discrimination, calibration, and reclassification. A total of 2,300 eligible cases were enrolled. Of them, 288 (12.5%) patients reached composite outcome and 214 (9.3%) patients reached ESRD during a median follow-up period of 30 months. Using the composite outcome for analysis, the Clinical, Limited, Full, and CKD models had relatively good performance with similar C statistics (0.81, 0.81, 0.82, and 0.82, respectively). While using ESRD as the end point, the four prediction models had better performance (all C statistics > 0.9). Furthermore, subgroup analysis showed that the models containing clinical and pathological variables (Full model and Limited model) had better discriminatory abilities than the models including only clinical indicators (Clinical model and CKD model) in low-risk patients characterized by higher baseline eGFR (≥60 ml/min/1.73 m2). In conclusion, we validated recently reported IgAN and CKD risk models in our Chinese IgAN cohort. Compared to pure clinical models, adding pathological variables will increase performance in predicting ESRD in low-risk IgAN patients with baseline eGFR ≥60 ml/min/1.73 m2.

Sequential administration of paricalcitol followed by IL-17 blockade for progressive refractory IgA nephropathy patients

“…The mean eGFR at baseline in our patients was lower than 60 mL/min/1.73 m 2 , which is considered an independent high-risk factor for developing end-stage renal disease 37 . Except for patient #3, the annual decline improved significantly to 4.9 mL/min/1.73 m 2 (mean), which is clinically meaningful.…”

External Validation of the Kidney Failure Risk Equation Among Urban Community-Based Chinese Patients With CKD

“…Regarding Chinese, as far as we know, only one study based on a multicenter IgA nephropathy cohort and another study based on a glomerular disease-specific cohort provided data for validation. 9 , 10 Therefore, the current study represents another effort to replicate the KFRE based on a CKD cohort that stemmed from primary care settings in China, and the patients had lower uACR and higher eGFR values than the original KFRE-establishing cohorts. Consistent with the previous studies based on the non-North American equations with lower risk calibration, we also observed that the discrimination was sufficiently good (Harrell’s C statistic was above 0.75) and that the calibration was acceptable.…”

“… 4 Previous validating studies of KFRE among Chinese patients were restricted to specific patients with IgA nephropathy or glomerular diseases. 9 , 10 Based on the electronic health record data of the China Kidney Disease Network (CK-NET)-Yinzhou study of community-dwelling residents in an eastern coastal area of China, the present study aimed to validate the accuracy of the KFRE and provide evidence for their potential clinical usage. 8 , 11 …”

External validation of the international prediction tool in Korean patients with immunoglobulin A nephropathy

“…In the same study, the validation cohort included more patients with other races/ethnicities, with only 15.5% of the cohort being Caucasian compared with 42% in the derivation cohort, indicating that the models performed well in different ethnic, geographic, and clinical settings [ 18 ]. Several external validation studies have also reported that the International IgA Nephropathy Prediction Tool performed well in different cohorts [ 28 – 30 ]. Considering this evidence, the recently published Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for glomerular diseases advocate the use of the International IgA Nephropathy Prediction Tool for risk quantification and shared decision-making with patients [ 6 ].…”