Risk scores to predict decreased glomerular filtration rate at 10 years in an Asian general population

Abstract

BackgroundAsians have among the highest prevalence of chronic kidney disease (CKD) or end-stage renal disease in the world. A risk score capable of identifying high risk individuals at the primary care level could allow targeted therapy to prevent future development of CKD. Risk scores for new CKD have been developed in US general populations, but the impact of various risks factors for development of CKD may differ in Asian subjects. In this study, we aimed to develop risk models and simplified risk scores to predict the development of decreased glomerular filtration rate (GFR) at 10 years in an Asian general population using readily obtainable clinical and laboratory parameters.MethodsEmployees of EGAT (The Electric Generating Authority of Thailand) were studied prospectively. Multivariable logistic regression models were used to assess risk factors and used to derive risk models and risk scores for developing decreased GFR at 10 years: Model 1 (Clinical only), Model 2 (Clinical + Limited laboratory tests), and Model 3 (Clinical + Full laboratory tests). The performance of the risk models or risk scores to predict incident cases with decreased GFR were evaluated by tests of calibration and discrimination.ResultsOf 3186 subjects with preserved GFR (eGFR ≥60) at baseline, 271 (8.5%) developed decreased GFR (eGFR < 60) at 10 years. Model 1 (Age, sex, systolic blood pressure, history of diabetes, and waist circumference) had good performance (χ2 = 9.02; AUC = 0.72). Model 2 (Age, Sex, systolic blood pressure, diabetes, glomerular filtration rate) had better discrimination (χ2 = 10.87, AUC = 0.79) than Model 1. Model 3 (Model 2+ Uric acid, Hemoglobin) did not provide significant improvement over Model 2. Based on these findings, simplified categorical risk scores were developed for Models 1 and 2.ConclusionsClinical or combined clinical and laboratory risk models or risk scores using tests readily available in a resource-limited setting had good accuracy and discrimination power to estimate the 10-year probability of developing decreased GFR in a Thai general population. The benefits of the risk scores in identifying high risk individuals in the Thai or other Asian communities for special intervention requires further studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-017-0653-z) contains supplementary material, which is available to authorized users.

A risk scoring system for the decreased glomerular filtration rate in Chinese general population

“…The kidney hemodynamics can be altered by these impacts, thereby affecting the progression of kidney diseases. 38 In this study, the gender was shown to be a predictive factor for the decreased GFR in Chinese general population, supported by the results of Saranburut et al 21 It is well known that GFR declines with age, which may be associated with the kidney structural changes. 39 At the macrostructural level, the volume of renal cortex reduces, surface coarseness augments, and the size and number of simple renal cysts raise with age; at the microstructural level, the histological characteristics of nephrosclerosis, such as tubular atrophy, interstitial fibrosis and glomerulosclerosis, are gradually evident with age.…”

“…46,47 This risk scoring system may exert a better predictive effect on the decreased GFR if the Asian coefficient for CKD-EPI equation is adopted in eGFR. 21 Moreover, the eGFR was measured only once, which may result in an overestimation of incident CKD. It is thus necessary to conduct more studies with repeated Scr measurements to confirm whether the decreased GFR occurs.…”

Risk scores for predicting incident chronic kidney disease among rural Chinese people: a village-based cohort study

“…Therefore, there may be selection bias. Additionally, compared with previous studies [24][25][26], this study is relatively small. Second, external validation has not been carried out because there are no data available from other similar studies in China.…”

“…In a recent study conducted in low-to middle-income [26], age, sex, SBP, diabetes, and WC were significant predictors for their clinical score, while age, sex, SBP, diabetes, and eGFR were predictors in the combined clinical and laboratory model. Both risk scores had a high degree of accuracy and discriminatory power in the Thai population (AUC 0.72-0.79).…”

The Study on Serum Urate acid Target for Retarding Renal function to Worse in Diabetes

“…Diabetes, a chronic systemic metabolic disease characterized by long-term hyperglycemia, leads to glomerular filtration rate (GFR) decline via continuous impairment of renal function and has been the main cause in end stage renal disease (ERSD) [8]. The GFR decline still hasn't been inhibited though the treatment has been actively used in controlling risk factors such as blood sugar, blood pressure, blood lipid and the renin-angiotensin system [9][10][11][12].…”