Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Nephrol Dial Transplant. 2020 Sep 1;35(9):1527-1538. doi: 10.1093/ndt/gfz018.
Prediction tools that identify chronic kidney disease (CKD) patients at a high risk of developing kidney failure have the potential for great clinical value, but limited uptake. The aim of the current study is to systematically review all available models predicting kidney failure in CKD patients, organize empirical evidence on their validity and ultimately provide guidance in the interpretation and uptake of these tools.
PubMed and EMBASE were searched for relevant articles. Titles, abstracts and full-text articles were sequentially screened for inclusion by two independent researchers. Data on study design, model development and performance were extracted. The risk of bias and clinical usefulness were assessed and combined in order to provide recommendations on which models to use.
Of 2183 screened studies, a total of 42 studies were included in the current review. Most studies showed high discriminatory capacity and the included predictors had large overlap. Overall, the risk of bias was high. Slightly less than half the studies (48%) presented enough detail for the use of their prediction tool in practice and few models were externally validated.
The current systematic review may be used as a tool to select the most appropriate and robust prognostic model for various settings. Although some models showed great potential, many lacked clinical relevance due to being developed in a prevalent patient population with a wide range of disease severity. Future research efforts should focus on external validation and impact assessment in clinically relevant patient populations.
能够识别出患有慢性肾脏病（CKD）且有发生肾衰竭高风险的患者的预测工具具有重要的临床价值，但目前尚未得到广泛应用。本研究旨在系统地回顾所有预测 CKD 患者发生肾衰竭的模型，总结其有效性的经验证据，最终为这些工具的解读和应用提供指导。
在 PubMed 和 EMBASE 中检索相关文献。由两名独立研究人员对标题、摘要和全文进行逐步筛选，以确定是否符合纳入标准。提取研究设计、模型开发和性能的数据。评估并综合了偏倚风险和临床实用性，以提供有关使用哪些模型的建议。
在 2183 篇筛选出的研究中，共有 42 项研究纳入了本次综述。大多数研究显示出了较高的区分能力，纳入的预测因素有很大的重叠。总体而言，偏倚风险较高。略低于一半的研究（48%）提供了足够的细节，可以在实际中使用其预测工具，但很少有模型经过外部验证。
本系统综述可作为选择适用于各种环境的最合适和最稳健的预后模型的工具。尽管一些模型显示出了巨大的潜力，但由于在疾病严重程度差异较大的流行患者群体中进行开发，许多模型缺乏临床相关性。未来的研究应集中于在具有临床意义的患者群体中进行外部验证和影响评估。
