Division of Nephrology-Hypertension, University of California, San Diego, La Jolla, California.
Division of Nephrology-Hypertension, University of California, Irvine, California; and.
Clin J Am Soc Nephrol. 2019 Feb 7;14(2):206-212. doi: 10.2215/CJN.07970718. Epub 2019 Jan 10.
The rate of progression to ESKD is variable, and prognostic information helps patients and physicians plan for future ESKD. We assessed the estimations of ESKD risk of patients with CKD and physicians and compared them with risk calculators and outcomes at 2 years.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This prospective observational study assessed 257 adult patients with CKD stages 3-5 and their nephrologists at University of California, San Diego and Veterans Affairs San Diego CKD clinics. Patients' and nephrologists' estimations of 2-year ESKD risk were evaluated, and objective estimation of 2-year risk was determined using kidney failure risk equations; actual incidence rates of ESKD and death were ascertained by chart review. Participants' baseline characteristics were compared across kidney failure risk equation risk levels and according to whether patients' estimations were more optimistic or pessimistic than physicians' estimations. We examined correlations between estimations and compared estimations with outcomes using statistics and calibration plots.
Average age was 65 (±13) years old, and eGFR was 34 (±13) ml/min per 1.73 m. Overall, 13% reached ESKD, and 9% died. About one quarter of patients gave estimates that were >20% more optimistic than physicians, and more than one in ten gave estimates that were >20% more pessimistic. Physicians' and kidney failure risk equation estimations had the strongest correlation (=0.72; <0.001) compared with 0.50 (<0.001) between physicians and patients and 0.47 (<0.001) between patients and kidney failure risk equation. Although all three estimations provided reasonable risk rankings ( statistics >0.8), physicians and patients overestimated risk compared with actual outcomes; no patient whose physician estimated a risk of ESKD <15% reached ESKD at 2 years. The kidney failure risk equation was best calibrated to actual ESKD risk.
Compared with actual ESKD incidence, the kidney failure risk equation outperformed patients' and physicians' estimations of ESKD incidence. Patients and physicians overestimated risk compared with the kidney failure risk equation.
终末期肾病（ESKD）的进展速度存在差异，预后信息有助于患者和医生规划未来的 ESKD。我们评估了慢性肾脏病（CKD）患者和医生对 ESKD 风险的估计，并将其与 2 年时的风险计算器和结局进行了比较。
设计、地点、参与者和测量方法：这项前瞻性观察研究评估了加利福尼亚大学圣地亚哥分校和退伍军人事务圣地亚哥 CKD 诊所的 257 名成年 CKD 3-5 期患者及其肾病医生。评估了患者和肾病医生对 2 年 ESKD 风险的估计，并用肾衰竭风险方程确定了 2 年风险的客观估计值；通过病历回顾确定 ESKD 和死亡的实际发生率。根据患者的估计值是否比医生的估计值更乐观或悲观，比较了参与者在肾衰竭风险方程风险水平上的基线特征。我们使用 统计量和校准图检查了估计值之间的相关性，并比较了估计值与结局。
平均年龄为 65（±13）岁，肾小球滤过率为 34（±13）ml/min/1.73m。总体而言，有 13%的患者进展为 ESKD，9%的患者死亡。大约四分之一的患者的估计值比医生的估计值乐观 20%以上，超过十分之一的患者的估计值比医生的估计值悲观 20%以上。与医生和患者之间的相关性（=0.50；<0.001）相比，医生和肾衰竭风险方程之间的相关性最强（=0.72；<0.001），与患者和肾衰竭风险方程之间的相关性（=0.47；<0.001）。尽管这三种估计都提供了合理的风险排名（ 统计量>0.8），但医生和患者对风险的估计都高于实际结果；没有患者的医生估计 ESKD 风险<15%，但在 2 年内进展为 ESKD。肾衰竭风险方程最能校准实际 ESKD 风险。
与实际 ESKD 发生率相比，肾衰竭风险方程优于患者和医生对 ESKD 发生率的估计。与肾衰竭风险方程相比，患者和医生高估了风险。
