Saranburut Krittika, Vathesatogkit Prin, Thongmung Nisakron, Chittamma Anchalee, Vanavanan Somlak, Tangstheanphan Tuangrat, Sritara Piyamitr, Kitiyakara Chagriya
Cardiovascular and Metabolic Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Rd, Bangkok, 10400, Thailand.
BMC Nephrol. 2017 Jul 17;18(1):240. doi: 10.1186/s12882-017-0653-z.
Asians 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.
Employees 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.
Of 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 (χ = 9.02; AUC = 0.72). Model 2 (Age, Sex, systolic blood pressure, diabetes, glomerular filtration rate) had better discrimination (χ = 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.
Clinical 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.
亚洲是世界上慢性肾脏病（CKD）或终末期肾病患病率最高的地区之一。一种能够在初级保健层面识别高危个体的风险评分，可实现针对性治疗，预防CKD的未来发展。美国普通人群中已开发出新发CKD的风险评分，但CKD发展的各种风险因素对亚洲人群的影响可能有所不同。在本研究中，我们旨在利用易于获取的临床和实验室参数，开发风险模型和简化风险评分，以预测亚洲普通人群10年后肾小球滤过率（GFR）下降的发生情况。
对泰国发电管理局（EGAT）的员工进行前瞻性研究。使用多变量逻辑回归模型评估风险因素，并用于推导10年后GFR下降的风险模型和风险评分：模型1（仅临床因素）、模型2（临床因素+有限的实验室检查）和模型3（临床因素+全面的实验室检查）。通过校准和区分测试评估风险模型或风险评分预测GFR下降的事件病例的性能。
在基线时3186名GFR正常（估算肾小球滤过率[eGFR]≥60）的受试者中，271名（8.5%）在10年后出现GFR下降（eGFR<60）。模型1（年龄、性别、收缩压、糖尿病史和腰围）表现良好（χ=9.02；曲线下面积[AUC]=0.72）。模型2（年龄、性别、收缩压、糖尿病、肾小球滤过率）比模型1具有更好的区分度（χ=10.87，AUC=0.79）。模型3（模型2+尿酸、血红蛋白）相比模型2没有显著改善。基于这些发现，为模型1和模型2开发了简化的分类风险评分。
在资源有限的环境中，使用易于获得的检查得出的临床或临床与实验室相结合的风险模型或风险评分，在估计泰国普通人群10年后发生GFR下降的概率方面具有良好的准确性和区分能力。风险评分在识别泰国或其他亚洲社区的高危个体以进行特殊干预方面的益处，需要进一步研究。
