Predicting Kidney Failure, Cardiovascular Disease and Death in Advanced CKD Patients

Chava L. Ramspek*, Rosemarijn Boekee, EQUAL study investigators, Marie Evans, Olof Heimburger, Charlotte M. Snead, Fergus J. Caskey, Claudia Torino, Gaetana Porto, Maciej Szymczak, Magdalena Krajewska, Christiane Drechsler, Christoph Wanner, Nicholas C. Chesnaye, Kitty J. Jager, Friedo W. Dekker, Maarten G.J. Snoeijs, Joris I. Rotmans, Merel van Diepen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Introduction: Predicting the timing and occurrence of kidney replacement therapy (KRT), cardiovascular events, and death among patients with advanced chronic kidney disease (CKD) is clinically useful and relevant. We aimed to externally validate a recently developed CKD G4+ risk calculator for these outcomes and to assess its potential clinical impact in guiding vascular access placement. Methods: We included 1517 patients from the European Quality (EQUAL) study, a European multicentre prospective cohort study of nephrology-referred advanced CKD patients aged ≥65 years. Model performance was assessed based on discrimination and calibration. Potential clinical utility for timing of referral for vascular access placement was studied with diagnostic measures and decision curve analysis (DCA). Results: The model showed a good discrimination for KRT and “death after KRT,” with 2-year concordance (C) statistics of 0.74 and 0.76, respectively. Discrimination for cardiovascular events (2-year C-statistic: 0.70) and overall death (2-year C-statistic: 0.61) was poorer. Calibration was fairly accurate. Decision curves illustrated that using the model to guide vascular access referral would generally lead to less unused arteriovenous fistulas (AVFs) than following estimated glomerular filtration rate (eGFR) thresholds. Conclusion: This study shows moderate to good predictive performance of the model in an older cohort of nephrology-referred patients with advanced CKD. Using the model to guide referral for vascular access placement has potential in combating unnecessary vascular surgeries.

Original languageEnglish
Pages (from-to)2230-2241
Number of pages12
JournalKidney International Reports
Volume7
Issue number10
DOIs
Publication statusPublished - Oct 2022

Bibliographical note

Funding Information:
The work on this study by CLR was supported by a grant from the Dutch Kidney Foundation (20OK016). The work on this study by MvD was supported by grants from the Dutch Kidney Foundation (16OKG12 & 20OK016). Main funding for the EQUAL study was received from the European Renal Association–European Dialysis and Transplant Association and contributions from the Swedish Medical Association, the Stockholm County Council ALF Medicine and Center for Innovative research, the Italian Society of Nephrology, the Dutch Kidney Foundation, the Young Investigators grant in Germany, and the National Institute for Health Research in the United Kingdom.

Publisher Copyright:
© 2022 International Society of Nephrology

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