Guía de práctica clínica para el tamizaje, diagnóstico y manejo de la enfermedad renal crónica en estadios 1 al 3 en el Seguro Social del Perú (EsSalud)

Bravo-Zúñiga, Jessica; Hinostoza-Sayas, Juana; Goicochea-Lugo, Sergio; Dolores-Maldonado, Gandy; Brañez-Condorena, Ana; Taype-Rondán, Álvaro; Vejarano, Carlos Yanar Pereda; Rosas, Carola Medina Sal y; Valdivia-Vega, Renzo; Haro, Fernando Mesías Gonzáles; Gaona, Luzmila Livaque; Muro, Victor Manuel Conetero; Guerrero, Gabriela Ayllón; Cáceres, Nelly Patricia Huancco; Munarriz, Cesar Antonio Loza; Herrera‐Añazco, Percy; Failoc-Rojas, Virgilio E.; Carrera-Acosta, Lourdes; Ruiz, Raúl Timaná; Garavito-Farro, Héctor

doi:10.35663/amp.2020.374.1843

Cited by 3 publications

(3 citation statements)

References 30 publications

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“…[17][18][19][20] However, in Peru, referral recommendations are primarily based on the isolated or combined use of estimated glomerular filtration rate (eGFR), albuminuria, urine albumin:creatinine ratio (uACR) thresholds. 21 These criteria do not incorporate individualised risks, potentially leading to the unnecessary referral of low-risk patients and the failure to refer high-risk patients. 17 22 The kidney failure risk equation (KFRE) is an individualised risk prediction equation for CKD patients' progression to kidney failure.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…International guidelines recommend using individualised risk prediction models to inform the appropriate time for nephrologist referral and KRT planning 17–20. However, in Peru, referral recommendations are primarily based on the isolated or combined use of estimated glomerular filtration rate (eGFR), albuminuria, urine albumin:creatinine ratio (uACR) thresholds 21. These criteria do not incorporate individualised risks, potentially leading to the unnecessary referral of low-risk patients and the failure to refer high-risk patients 17 22…”

Section: Introductionmentioning

confidence: 99%

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Multicentre external validation of the prognostic model kidney failure risk equation in patients with CKD stages 3 and 4 in Peru: a retrospective cohort study

Bravo-Zúñiga,

Chávez-Gómez,

Soto-Becerra

2024

BMJ Open

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ObjectivesTo externally validate the four-variable kidney failure risk equation (KFRE) in the Peruvian population for predicting kidney failure at 2 and 5 years.DesignA retrospective cohort study.Setting17 primary care centres from the Health’s Social Security of Peru.ParticipantsPatients older than 18 years, diagnosed with chronic kidney disease stage 3a–3b–4 and 3b–4, between January 2013 and December 2017. Patients were followed until they developed kidney failure, died, were lost, or ended the study (31 December 2019), whichever came first.Primary and secondary outcome measuresPerformance of the KFRE model was assessed based on discrimination and calibration measures considering the competing risk of death.ResultsWe included 7519 patients in stages 3a–4 and 2798 patients in stages 3b–4. The estimated cumulative incidence of kidney failure, accounting for competing event of death, at 2 years and 5 years, was 1.52% and 3.37% in stages 3a–4 and 3.15% and 6.86% in stages 3b–4. KFRE discrimination at 2 and 5 years was high, with time-dependent area under the curve and C-index >0.8 for all populations. Regarding calibration in-the-large, the observed to expected ratio and the calibration intercept indicated that KFRE underestimates the overall risk at 2 years and overestimates it at 5 years in all populations.ConclusionsThe four-variable KFRE models have good discrimination but poor calibration in the Peruvian population. The model underestimates the risk of kidney failure in the short term and overestimates it in the long term. Further research should focus on updating or recalibrating the KFRE model to better predict kidney failure in the Peruvian context before recommending its use in clinical practice.

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Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Multicentre external validation of the prognostic model kidney failure risk equation in patients with CKD stages 3 and 4 in Peru: a retrospective cohort study

Bravo-Zúñiga,

Chávez-Gómez,

Soto-Becerra

2024

BMJ Open

Self Cite

View full text Add to dashboard Cite

show abstract

“…International guidelines recommend using individualized risk prediction models to inform the appropriate time for nephrologist referral and KRT planning (17)(18)(19)(20). However, in Peru, recommendations for referral are primarily based on the isolated or combined use of eGFR, albuminuria, or ACR thresholds [21]. These criteria do not employ individualized risks, which may lead to the unnecesary referral of low-risk patients and the failure to refer high-risk patients [17,22].…”

Section: Introductionmentioning

confidence: 99%

Kidney Failure Prediction: Multicenter External Validation of KFRE Model in Patients with CKD Stages 3-4 in Peru

Bravo-Zúñiga

Chávez-Gómez

Soto-Becerra

2023

Preprint

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Objectives: To externally validate the 4-variable Kidney Failure Risk Equation (KFRE) in the Peruvian population for predicting kidney failure at 2 and 5 years. Design: A retrospective cohort study. Setting: 17 primary care centers from the Health's Social Security of Peru. Participants: Patients older than 18 years, diagnosed with chronic kidney disease (CKD) stage 3a-3b-4 and 3b-4, between January 2013 and December 2017. Patients were followed until they developed kidney failure, died, were lost, or ended the study (December 31, 2019), whichever came first. Primary and Secondary Outcome Measures: Performance of the KFRE model was assessed based on discrimination and calibration measures considering the competing risk of death. Results: We included 7519 patients in stages 3a-4 and 2,798 patients in stages 3b-4. The estimated cumulative incidence of kidney failure, accounting for competing event of death, at two years and five years was 1.52% and 3.37% in stages 3a-4 and 3.15% and 6.86% in stages 3b-4. KFRE discrimination at 2 and 5 years was high, with Time-Dependent Area Under the Curve (AUC-td) and C-index > 0.8 for all populations. Regarding calibration in-the-large, the Observed-to-Expected (O/E) ratio and the calibration intercept indicated that KFRE underestimates the overall risk at two years and overestimates it at 5-years in all populations. Conclusions: The 4-variable KFRE models have good discrimination but poor calibration in the Peruvian population. The model underestimates the risk of kidney failure in the short term and overestimates it in the long term. Further research should focus on updating or recalibrating the KFRE model to better predict kidney failure in the Peruvian context before recommending its use in clinical practice.

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Benefit of the microalbuminuria in the investigation of the renal damage early on patient older adults

Rodríguez Ramos,

Herrera Miranda,

Rodríguez Boffill

2023

Salud, Ciencia y Tecnología - Serie de Conferencias

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Introducción: La presencia de microalbuminuria es un potente factor de predicción para el futuro desarrollo de varias enfermedades. Objetivo: determinar la utilidad de la microalbuminuria en la pesquisa del daño renal temprano en adultos mayores. Método: Se realizó un estudio observacional, descriptivo y transversal, que incluyó pacientes ambulatorios mayores de 60 años de edad, de ambos sexos, con factores de riesgo conocidos para enfermedad renal crónica durante el año 2022. De un universo de 2500, fueron procesadas mediante muestreo probabilístico 1300 muestras de orina de pacientes recibidas en el laboratorio de Microbiología procedentes del Policlinico Luís Augusto Turcios Lima, para la pesquisa de daño renal. A todas las muestras de orina se les realizó examen de orina y la determinación de microalbuminuria. Se determinó la media (X) y desviación estándar (DS) y la fuerza de asociación odds ratio (OR) de estas variables y su intervalo de confianza del 95% (IC 95%), así como el Chi cuadrado y el estadígrafo Z con un nivel de significación estadística de p < 0,05. Resultados: Predomino la edad de 60 a 69 años, a expensas del sexo femenino y jubilados. La microalbuminuria estuvo presente en el 19,4 % de los pacientes, en el 21,7 % de los hipertensos y en el 8,6 % de los diabéticos. El antecedente personal de hiperlipemia, estuvo presente en más de 5 veces. Conclusiones: La determinación de microalbuminuria es útil en la pesquisa del daño renal temprano en pacientes adultos mayores con factores de riesgo.

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Guía de práctica clínica para el tamizaje, diagnóstico y manejo de la enfermedad renal crónica en estadios 1 al 3 en el Seguro Social del Perú (EsSalud)

Cited by 3 publications

References 30 publications

Multicentre external validation of the prognostic model kidney failure risk equation in patients with CKD stages 3 and 4 in Peru: a retrospective cohort study

Multicentre external validation of the prognostic model kidney failure risk equation in patients with CKD stages 3 and 4 in Peru: a retrospective cohort study

Kidney Failure Prediction: Multicenter External Validation of KFRE Model in Patients with CKD Stages 3-4 in Peru

Benefit of the microalbuminuria in the investigation of the renal damage early on patient older adults

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