Predicting timing of clinical outcomes in patients with chronic kidney disease and severely decreased glomerular filtration rate

Morgan E. Grams, Yingying Sang, Shoshana H. Ballew, Juan Jesus Carrero, Ognjenka Djurdjev, Hiddo J.L. Heerspink, Kevin Ho, Sadayoshi Ito, Angharad Marks, David Naimark, Danielle M. Nash, Sankar D. Navaneethan, Mark Sarnak, Benedicte Stengel, Frank L.J. Visseren, Angela Yee Moon Wang, Anna Köttgen, Andrew S. Levey, Mark Woodward, Kai Uwe EckardtBrenda Hemmelgarn, Josef Coresh

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Patients with chronic kidney disease and severely decreased glomerular filtration rate (GFR) are at high risk for kidney failure, cardiovascular disease (CVD) and death. Accurate estimates of risk and timing of these clinical outcomes could guide patient counseling and therapy. Therefore, we developed models using data of 264,296 individuals in 30 countries participating in the international Chronic Kidney Disease Prognosis Consortium with estimated GFR (eGFR)s under 30 ml/min/1.73m2. Median participant eGFR and urine albumin-to-creatinine ratio were 24 ml/min/1.73m2 and 168 mg/g, respectively. Using competing-risk regression, random-effect meta-analysis, and Markov processes with Monte Carlo simulations, we developed two- and four-year models of the probability and timing of kidney failure requiring kidney replacement therapy (KRT), a non-fatal CVD event, and death according to age, sex, race, eGFR, albumin-to-creatinine ratio, systolic blood pressure, smoking status, diabetes mellitus, and history of CVD. Hypothetically applied to a 60-year-old white male with a history of CVD, a systolic blood pressure of 140 mmHg, an eGFR of 25 ml/min/1.73m2 and a urine albumin-to-creatinine ratio of 1000 mg/g, the four-year model predicted a 17% chance of survival after KRT, a 17% chance of survival after a CVD event, a 4% chance of survival after both, and a 28% chance of death (9% as a first event, and 19% after another CVD event or KRT). Risk predictions for KRT showed good overall agreement with the published kidney failure risk equation, and both models were well calibrated with observed risk. Thus, commonly-measured clinical characteristics can predict the timing and occurrence of clinical outcomes in patients with severely decreased GFR.

Original languageEnglish
Pages (from-to)1442-1451
Number of pages10
JournalKidney international
Volume93
Issue number6
DOIs
Publication statusPublished - 2018 Jun

Keywords

  • albuminuria
  • cardiovascular disease
  • chronic kidney disease

ASJC Scopus subject areas

  • Nephrology

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    Grams, M. E., Sang, Y., Ballew, S. H., Carrero, J. J., Djurdjev, O., Heerspink, H. J. L., Ho, K., Ito, S., Marks, A., Naimark, D., Nash, D. M., Navaneethan, S. D., Sarnak, M., Stengel, B., Visseren, F. L. J., Wang, A. Y. M., Köttgen, A., Levey, A. S., Woodward, M., ... Coresh, J. (2018). Predicting timing of clinical outcomes in patients with chronic kidney disease and severely decreased glomerular filtration rate. Kidney international, 93(6), 1442-1451. https://doi.org/10.1016/j.kint.2018.01.009