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Development and validation of a model to predict 5-year risk of death without ESRD among older adults with CKD.
Tuesday,2015-04-07 12:39 America/Los_Angeles — zdrager
| Title | Development and validation of a model to predict 5-year risk of death without ESRD among older adults with CKD. |
| Publication Type | Journal Article |
| Year of Publication | 2015 |
| Authors | Bansal, N, Katz, R, de Boer, IH, Peralta, CA, Fried, LF, Siscovick, DS, Rifkin, DE, Hirsch, C, Cummings, SR, Harris, TB, Kritchevsky, SB, Sarnak, MJ, Shlipak, MG, Ix, JH |
| Journal | Clin J Am Soc Nephrol |
| Volume | 10 |
| Issue | 3 |
| Pagination | 363-71 |
| Date Published | 2015 Mar 6 |
| ISSN | 1555-905X |
| Keywords | Age Factors, Aged, Aged, 80 and over, Albuminuria, Continental Population Groups, Creatinine, Diabetes Mellitus, Female, Glomerular Filtration Rate, Heart Failure, Humans, Male, Proportional Hazards Models, Regression Analysis, Renal Insufficiency, Chronic, Risk Factors, Sex Factors, Smoking, Stroke |
| Abstract | <p><b>BACKGROUND AND OBJECTIVES: </b>CKD is associated with mortality. Accurate prediction tools for mortality may guide clinical decision-making, particularly among elderly persons with CKD.</p><p><b>DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: </b>A prediction equation was developed for 5-year risk of mortality among participants with CKD in the Cardiovascular Health Study. Sixteen candidate predictor variables were explored, which included demographics, physical examination measures, comorbidity, medication use, and kidney function measures (eGFR calculated from serum creatinine and the CKD Epidemiology Collaboration equation and the urine albumin-to-creatinine ratio). Models were developed using Cox regression and evaluated using c statistics. A final parsimonious model was externally validated in an independent cohort of community-living elders with CKD in the Health, Aging, and Body Composition Study.</p><p><b>RESULTS: </b>The development cohort included 828 participants who had a mean age of 80 (±5.6) years and an eGFR of 47 (±11) ml/min per 1.73 m(2), and median albumin-to-creatinine ratio of 13 (interquartile range 6-51) mg/g. The validation cohort included 789 participants who had a mean age of 74 (±2.8) years and an eGFR of 50 (±9) ml/min per 1.73 m(2), and median albumin-to-creatinine ratio of 13 (interquartile range 6-42) mg/g. The final model for 5-year mortality risk included age, sex, race, eGFR, urine albumin-to-creatinine ratio, smoking, diabetes mellitus, and history of heart failure and stroke (c statistic=0.72; 95% confidence interval, 0.68 to 0.74). When a point-based system was assigned for each of nine variables in the equation, the estimated risk of death within 5 years ranged from 3.8% among participants with the lowest scores to 83.6% among participants with nine points. The model performed fair in external validation (c statistic=0.69; 95% confidence interval, 0.64 to 0.74).</p><p><b>CONCLUSIONS: </b>A simple prediction tool using nine readily available clinical variables can assist in predicting 5-year mortality risk in elderly patients with CKD, which may be useful in counseling patients and guiding clinical decision making.</p> |
| DOI | 10.2215/CJN.04650514 |
| Alternate Journal | Clin J Am Soc Nephrol |
| PubMed ID | 25710804 |
| PubMed Central ID | PMC4348680 |
| Grant List | ,N01-HC85083 / HC / NHLBI NIH HHS / United States AG023629 / AG / NIA NIH HHS / United States HHSN268200800007C / / PHS HHS / United States HHSN268201200036C / / PHS HHS / United States HL080295 / HL / NHLBI NIH HHS / United States K23 DK088865 / DK / NIDDK NIH HHS / United States K23 DK091521 / DK / NIDDK NIH HHS / United States K23DK088865 / DK / NIDDK NIH HHS / United States N01-AG-6-2101 / AG / NIA NIH HHS / United States N01-AG-6-2103 / AG / NIA NIH HHS / United States N01-AG-6-2106 / AG / NIA NIH HHS / United States N01-HC55222 / HC / NHLBI NIH HHS / United States N01-HC85079 / HC / NHLBI NIH HHS / United States N01-HC85080 / HC / NHLBI NIH HHS / United States N01-HC85081 / HC / NHLBI NIH HHS / United States N01-HC85082 / HC / NHLBI NIH HHS / United States N01-HC85086 / HC / NHLBI NIH HHS / United States P30 DK017047 / DK / NIDDK NIH HHS / United States R01-AG028050 / AG / NIA NIH HHS / United States R01-NR012459 / NR / NINR NIH HHS / United States R01AG027002 / AG / NIA NIH HHS / United States / / Intramural NIH HHS / United States |
ePub date:
2015 Feb 20