Chiu Helen H L, Tangri Navdeep, Djurdjev Ognjenka, Barrett Brendan J, Hemmelgarn Brenda R, Madore François, Rigatto Claudio, Muirhead Norman, Sood Manish M, Clase Catherine M, Levin Adeera
Nephrology Research, Providence Health Care Research Institute, 4th floor, 1125 Howe Street, Vancouver, BC V6Z 2K8 Canada ; BC Provincial Renal Agency, Vancouver, BC Canada.
Department of Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, MB Canada.
Can J Kidney Health Dis. 2015 Dec 20;2:53. doi: 10.1186/s40697-015-0088-z. eCollection 2015.
Predicting the clinical trajectories of chronic kidney disease (CKD) to discern personalized care remains a complex challenge in nephrology. Understanding the appropriate risk thresholds and time frame associated with predicting risks of key outcomes (kidney failure, cardiovascular (CV) events, and death) is critical in facilitating decision-making. As part of an exploratory research and practice support needs assessment, we aimed to determine the importance of the time frames for predicting key outcomes, and to assess the perceived demand for risk prediction tools among Canadian nephrologists.
A web-based survey was developed by a pan-Canadian expert panel of practitioners. Upon pre-test for clarity and ease of completion, the final survey was nationally deployed to Canadian nephrologists. Anonymous responses were gathered over a 4-month period. The results were analyzed using descriptive statistics.
One hundred eleven nephrologists responded to our survey. The majority of the respondents described prediction of events over time frames of 1-5 years as being "extremely important" or "very important" to decision-making on a 5-point Likert scale. To plan for arteriovenous fistula referral, the respondents deemed thresholds which would predict probability of kidney failure between >30 and >50 % at 1 year, as useful, while many commented that the rate of progression should be included for decision-making. Over 80 % of the respondents were not satisfied with their current ability to predict the progression to kidney failure, CV events, and death. Most of them indicated that they would value and use validated risk scores for decision-making.
Our national survey of nephrologists shows that the risk prediction for major adverse clinical outcomes is valuable in CKD at multiple time frames and risk thresholds. Further research is required in developing relevant and meaningful risk prediction models for clinical decision-making in patient-centered CKD care.
预测慢性肾脏病（CKD）的临床病程以实现个性化治疗，仍是肾脏病学领域一项复杂的挑战。了解与预测关键结局（肾衰竭、心血管（CV）事件和死亡）风险相关的合适风险阈值和时间框架，对于促进决策至关重要。作为探索性研究和实践支持需求评估的一部分，我们旨在确定预测关键结局的时间框架的重要性，并评估加拿大肾脏病学家对风险预测工具的感知需求。
由加拿大全国的从业者专家小组开发了一项基于网络的调查。在进行清晰度和易完成性的预测试后，最终调查在全国范围内向加拿大肾脏病学家进行了部署。在4个月的时间里收集了匿名回复。使用描述性统计分析结果。
111名肾脏病学家回复了我们的调查。大多数受访者在5点李克特量表上表示，预测1 - 5年时间框架内的事件对决策“极其重要”或“非常重要”。为计划动静脉内瘘转诊，受访者认为预测1年时肾衰竭概率在>30%至>50%之间的阈值是有用的，同时许多人评论说决策时应纳入进展速度。超过80%的受访者对他们目前预测肾衰竭、CV事件和死亡进展的能力不满意。他们中的大多数人表示，他们会重视并使用经过验证的风险评分来进行决策。
我们对肾脏病学家的全国性调查表明，在多个时间框架和风险阈值下，对慢性肾脏病主要不良临床结局的风险预测具有重要价值。需要进一步开展研究，以开发相关且有意义的风险预测模型，用于以患者为中心的慢性肾脏病护理中的临床决策。
