Independent External Validation and Comparison of Death and Kidney Replacement Therapy Prediction Models in Advanced CKD

Thanabalasingam, Susan; Iliescu, Eduard A.; Norman, Patrick; Day, Andrew G.; Akbari, Ayub; Hundemer, Gregory L.; White, Christine

doi:10.1016/j.xkme.2022.100440

Cited by 6 publications

(8 citation statements)

References 25 publications

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“…It is noteworthy that the KFRE has been externally validated in several independent external studies worldwide 16 23 30 38–49. However, the majority of these validations have been conducted in North American23 30 39 41 43–48 or European countries,16 30 40 49 with more recent validations taking place in other Asian countries 38 42.…”

Section: Discussionmentioning

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

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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: Discussionmentioning

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

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“…It is noteworthy that the Kidney Failure Risk Equation (KFRE) has been externally validated in several independent external studies worldwide [16,23,30,[38][39][40][41][42][43][44][45][46][47][48][49]. However, the majority of these validations have been conducted in North American [23,30,39,41,[43][44][45][46][47][48] or European countries [16,30,40,49], with more recent validations taking place in other Asian countries [38,42]. Upon conducting a systematic literature search, we were unable to identify any published external validation studies of KFRE specifically within the Latin American population at primary care level.…”

Section: Comparison With Previous Literaturementioning

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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“… 10 In two recent studies in Canadian advanced CKD populations, the KFRE-2 C-statistic was 0.83, and a slight tendency to overestimate risk was observed in both. 11 , 14 …”

Section: Introductionmentioning

confidence: 99%

“…9 The KFREs' performance has been validated in CKD patients in various settings, and implementation of KFRE at a policy level is gaining traction both within Canada and abroad. [10][11][12][13][14][15] In a large multinational meta-analysis, 2-year KRFE (KFRE-2) discriminative ability was excellent with a C-statistic of 0.9. 10 In its North American cohorts, KFRE-2 calibration was described as "adequate," with both underestimation and overestimation of risk depending on cohort.…”

Section: Introductionmentioning

confidence: 99%

“…10 In two recent studies in Canadian advanced CKD populations, the KFRE-2 C-statistic was 0.83, and a slight tendency to overestimate risk was observed in both. 11,14 As recommended by KDIGO and others, in many highly resourced jurisdictions, patients with advanced CKD receive multidisciplinary kidney care. 8,16 Multidisciplinary kidney clinics aim to delay the progression of CKD, mitigate suboptimal initiation of KRT, and improve quality of life and survival.…”

Section: Introductionmentioning

confidence: 99%

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Death and Dialysis Following Discharge From Chronic Kidney Disease Clinic: A Retrospective Cohort Study

Che

Iliescu

Thanabalasingam

et al. 2022

Can J Kidney Health Dis

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Background: Multidisciplinary care is recommended for patients with advanced chronic kidney disease (CKD). A formalized, risk-based approach to CKD management is being adopted in some jurisdictions. In Ontario, Canada, the eligibility criteria for multidisciplinary CKD care funding were revised between 2016 and 2018 to a 2 year risk of kidney replacement therapy (KRT) greater than 10% calculated by the 4-variable Kidney Failure Risk Equation (KFRE). Implementation of the risk-based approach has led to the discharge of prevalent CKD patients. Objective: The primary objective of this study was to determine the frequency of occurrence of death and KRT initiation in patients discharged from CKD clinic. Design: Retrospective cohort study Setting: Single center multidisciplinary CKD clinic in Ontario, Canada Patients: Four hundred and twenty five patients seen at least once in 2013 at the multidisciplinary CKD clinic Measurements: Outcomes included discharge status, death, re-referral and KRT initiation. Reasons for discharge were recorded. Methods: Outcomes were extracted from available electronic medical records and the provincial death registry between the patient’s initial clinic visit in 2013 and January 1, 2020. KFRE-2 scores were calculated using the 4-variable KFRE equation. The hazard rates of death and KRT after discharge due to stable eGFR/low KFRE were compared to patients who remained in the clinic. Results: Of the 425 CKD patients, 69 (16%) and 19 (4%) were discharged to primary care and general nephrology, respectively. Of those discharged, 7 (8%) were re-referred to nephrology or CKD clinic, while only 2 (2%) discharged patients required subsequent KRT. The hazard of mortality was reduced after discharge from the clinic due to stable eGFR/low KFRE (adjusted HR = 0.45 [95% CI, 0.25-0.78, P = .005]). Limitations: Single center, observational retrospective study design and unknown kidney function over time post discharge for most patients Conclusions: Discharge of low risk patients from multidisciplinary CKD clinic appears feasible and safe, with fewer than 1 in 40 discharged patients subsequently initiated on KRT over the following 7 years.

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Independent External Validation and Comparison of Death and Kidney Replacement Therapy Prediction Models in Advanced CKD

Cited by 6 publications

References 25 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

Death and Dialysis Following Discharge From Chronic Kidney Disease Clinic: A Retrospective Cohort Study

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