Schlackow Iryna, Kent Seamus, Herrington William, Emberson Jonathan, Haynes Richard, Reith Christina, Wanner Christoph, Fellström Bengt, Gray Alastair, Landray Martin J, Baigent Colin, Mihaylova Borislava
Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Heart. 2017 Dec;103(23):1880-1890. doi: 10.1136/heartjnl-2016-310970. Epub 2017 Aug 5.
To present a long-term policy model of cardiovascular disease (CVD) in moderate-to-advanced chronic kidney disease (CKD).
A Markov model with transitions between CKD stages (3B, 4, 5, on dialysis, with kidney transplant) and cardiovascular events (major atherosclerotic events, haemorrhagic stroke, vascular death) was developed with individualised CKD and CVD risks estimated using the 5 years' follow-up data of the 9270 patients with moderate-to-severe CKD in the Study of Heart and Renal Protection (SHARP) and multivariate parametric survival analysis. The model was assessed in three further CKD cohorts and compared with currently used risk scores.
Higher age, previous cardiovascular events and advanced CKD were the main contributors to increased individual disease risks. CKD and CVD risks predicted by the state-transition model corresponded well to risks observed in SHARP and external cohorts. The model's predictions of vascular risk and progression to end-stage renal disease were better than, or comparable to, those produced by other risk scores. As an illustration, at age 60-69 years, projected survival for SHARP participants in CKD stage 3B was 13.5 years (10.6 quality-adjusted life years (QALYs)) in men and 14.8 years (10.7 QALYs) in women. Corresponding projections for participants on dialysis were 7.5 (5.6 QALYs) and 7.8 years (5.4 QALYs). A non-fatal major atherosclerotic event reduced life expectancy by about 2 years in stage 3B and by 1 year in dialysis.
The SHARP CKD-CVD model is a novel resource for evaluating health outcomes and cost-effectiveness of interventions in CKD.
NCT00125593 and ISRCTN54137607; Post-results.
提出中重度慢性肾脏病（CKD）患者心血管疾病（CVD）的长期政策模型。
建立一个马尔可夫模型，该模型涵盖CKD各阶段（3B期、4期、5期、透析期、肾移植后）之间的转换以及心血管事件（主要动脉粥样硬化事件、出血性中风、血管性死亡），使用心脏和肾脏保护研究（SHARP）中9270例中重度CKD患者的5年随访数据及多变量参数生存分析来估计个体的CKD和CVD风险。该模型在另外三个CKD队列中进行了评估，并与目前使用的风险评分进行比较。
年龄较大、既往有心血管事件以及CKD晚期是个体疾病风险增加的主要因素。状态转换模型预测的CKD和CVD风险与SHARP研究及外部队列中观察到的风险高度吻合。该模型对血管风险和终末期肾病进展的预测优于或等同于其他风险评分。举例来说，在60 - 69岁时，SHARP研究中CKD 3B期参与者的预计男性生存期为13.5年（质量调整生命年（QALY）为10.6），女性为14.8年（QALY为10.7）。透析患者的相应预测生存期为7.5年（QALY为5.6）和7.8年（QALY为
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