Tan Vivian S, Garg Amit X, McArthur Eric, Patzer Rachel E, Gander Jennifer, Roshanov Pavel, Kim S Joseph, Knoll Greg A, Yohanna Seychelle, McCallum Megan K, Naylor Kyla L
Division of Nephrology, Western University, London, ON, Canada.
Institute for Clinical Evaluative Sciences, London, ON, Canada.
Can J Kidney Health Dis. 2018 Oct 4;5:2054358118799693. doi: 10.1177/2054358118799693. eCollection 2018.
Many patients with end-stage kidney disease (ESKD) do not appreciate how their survival may differ if treated with a kidney transplant compared with dialysis. A risk calculator (iChoose Kidney) developed and validated in the United States provides individualized mortality estimates for different treatment options (dialysis vs living or deceased donor kidney transplantation). The calculator can be used with patients and families to help patients make more educated treatment decisions.
To validate the iChoose Kidney risk calculator in Ontario, Canada.
External validation study.
We used several linked administrative health care databases from Ontario, Canada.
We included 22 520 maintenance dialysis patients and 4505 kidney transplant recipients. Patients entered the cohort between 2004 and 2014.
Three-year all-cause mortality.
We assessed model discrimination using the C-statistic. We assessed model calibration by comparing the observed versus predicted mortality risk and by using smoothed calibration plots. We used multivariable logistic regression modeling to recalibrate model intercepts using a correction factor, when appropriate.
In our final version of the iChoose Kidney model, we included the following variables: age (18-80 years), sex (male, female), race (white, black, other), time on dialysis (<6 months, 6-12 months, >12 months), and patient comorbidities (hypertension, diabetes, and/or cardiovascular disease). Over the 3-year follow-up period, 33.3% of dialysis patients and 6.2% of kidney transplant recipients died. The discriminatory ability was moderate (C-statistic for dialysis: 0.70, 95% confidence interval [CI]: 0.69-0.70, and C-statistic for transplant: 0.72, 95% CI: 0.69-0.75). The 3-year observed and predicted mortality estimates were comparable and even more so after we recalibrated the intercepts in 2 of our models (dialysis and deceased donor kidney transplantation). As done in the United States, we developed a Canadian Web site and an iOS application called Dialysis vs. Kidney Transplant- Estimated Survival in Ontario.
Missing data in our databases precluded the inclusion of all variables that were in the original iChoose Kidney (ie, patient ethnicity and low albumin). We were unable to perform all preplanned analyses due to the limited sample size.
The original iChoose Kidney risk calculator was able to adequately predict mortality in this Canadian (Ontario) cohort of ESKD patients. After minor modifications, the predictive accuracy improved. The Dialysis vs. Kidney Transplant- Estimated Survival in Ontario risk calculator may be a valuable resource to help ESKD patients make an informed decision on pursuing kidney transplantation.
许多终末期肾病（ESKD）患者并不了解与透析相比，接受肾移植治疗其生存率会有怎样的差异。在美国开发并验证的一种风险计算器（iChoose Kidney）可针对不同治疗方案（透析与活体或 deceased donor 肾移植）提供个体化的死亡率估计。该计算器可用于患者及其家属，以帮助患者做出更明智的治疗决策。
在加拿大安大略省验证 iChoose Kidney 风险计算器。
外部验证研究。
我们使用了来自加拿大安大略省的多个相关行政医疗保健数据库。
我们纳入了 22520 名维持性透析患者和 4505 名肾移植受者。患者于 2004 年至 2014 年间进入队列。
三年全因死亡率。
我们使用 C 统计量评估模型的辨别力。通过比较观察到的与预测的死亡风险，并使用平滑校准图来评估模型校准。必要时，我们使用多变量逻辑回归建模，通过校正因子重新校准模型截距。
在我们最终版的 iChoose Kidney 模型中，我们纳入了以下变量：年龄（18 - 80 岁）、性别（男性、女性）、种族（白人、黑人、其他）、透析时间（<6 个月、6 - 12 个月、>12 个月）以及患者合并症（高血压、糖尿病和/或心血管疾病）。在三年的随访期内，33.3%的透析患者和 6.2%的肾移植受者死亡。辨别能力中等（透析的 C 统计量：0.70，95%置信区间[CI]：0.69 - 0.70，移植的 C 统计量：0.72，95%CI：0.69 - 0.75）。三年观察到的和预测的死亡率估计值具有可比性，在我们对两个模型（透析和 deceased donor 肾移植）的截距进行重新校准后更是如此。如同在美国所做的那样，我们开发了一个加拿大网站以及一款名为“透析与肾移植——安大略省生存预估”的 iOS 应用程序。
我们数据库中的缺失数据使得无法纳入原始 iChoose Kidney 中的所有变量（即患者种族和低白蛋白）。由于样本量有限，我们无法进行所有预先计划的分析。
原始的 iChoose Kidney 风险计算器能够充分预测该加拿大（安大略省）ESKD 患者队列中的死亡率。经过微小修改后，预测准确性有所提高。“透析与肾移植——安大略省生存预估”风险计算器可能是帮助 ESKD 患者就肾移植做出明智决策的宝贵资源。
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