Ingwiller Maxime, Krummel Thierry, Dimitrov Yves, Muller Clotilde, Ott Julien, Chantrel François, Klein Alexandre, Hannedouche Thierry
Department of Nephrology, NHC, Hôpitaux Universitaires de Strasbourg, 1, place de l'Hôpital, 67000, Strasbourg, France.
Dialysis Center, AURAL Strasbourg, Strasbourg, France.
Int Urol Nephrol. 2022 Sep;54(9):2335-2342. doi: 10.1007/s11255-022-03138-z. Epub 2022 Feb 9.
The risk of ESKD is highly heterogeneous among renal diseases, and risk scores were developed to account for multiple progression factors. Kidney failure risk equation (KFRE) is the most widely accepted, although external validation is scarce. The objective of this study was to evaluate the usefulness of this score in a French case-control cohort and test the pertinence of the proposed thresholds.
A retrospective case-control study comparing a group of patients starting renal replacement therapy (RRT) to a group of patients with CKD stages 3-5. Multivariate analysis to assess the predictors of ESKD risk. Discrimination of 4-, 6- and 8-variable scores using ROC curves and compared with eGFR alone and albumin/creatinine ratio (ACR) alone.
314 patients with a ratio of 1 case for 1 control. In multivariate analysis, increasing age and higher eGFR were associated with a lower risk of ESKD (OR 0.62, 95% CI 0.48-0.79; and OR 0.72, 95% CI 0.59-0.86, respectively). The log-transformed ACR was associated with a higher risk of ESKD (OR 1.25 per log unit, 95% CI 1.02-1.55). The 4-variable score was significantly higher in the RRT group than in the CKD-ND group, and was more efficient than the eGFR (AUROC 0.66, 95% CI 0.60-0.72, p = 0.018) and the log-transformed ACR (AUROC 0.63 95% CI 0.60-0.72, p = 0.0087) to predict ESKD. The 6-variable score including BP metrics and diabetes was not more discriminant as the 4-variable score. The 8-variable score had similar performance compared with the 4-score (AUROC 8-variable score: 0.70, 95% CI 0.64-0.76, p = 0.526). A 40% and 20% score thresholds were not superior to eGFR < 15 and 20 mL/min/1.73 m, respectively. A 10% threshold was more specific than an eGFR < 30 mL/min/1.73 m.
KFRE was highly discriminant between patients progressing to ESKD vs those non-progressing. The 4-variable score may help stratify renal risk and referral in the numerous patients with stage 3 CKD. Conversely, the proposed thresholds for creating vascular access or preemptive transplantation were not superior to eGFR alone.
终末期肾病（ESKD）的风险在肾脏疾病中高度异质，已开发风险评分以考虑多种进展因素。肾衰竭风险方程（KFRE）是最广泛接受的，尽管外部验证很少。本研究的目的是评估该评分在法国病例对照队列中的有用性，并测试所提议阈值的相关性。
一项回顾性病例对照研究，比较一组开始肾脏替代治疗（RRT）的患者与一组慢性肾脏病（CKD）3 - 5期患者。多变量分析以评估ESKD风险的预测因素。使用ROC曲线对4变量、6变量和8变量评分进行鉴别，并与单独的估算肾小球滤过率（eGFR）和单独的白蛋白/肌酐比值（ACR）进行比较。
314例患者，病例与对照比例为1:1。在多变量分析中，年龄增加和较高的eGFR与较低的ESKD风险相关（OR分别为0.62，95%CI 0.48 - 0.79；以及OR为0.72，95%CI 0.59 - 0.86）。对数转换后的ACR与较高的ESKD风险相关（每对数单位OR为1.25，95%CI 1.02 - 1.55）。4变量评分在RRT组显著高于CKD非透析组，并且在预测ESKD方面比eGFR（曲线下面积[AUC]为0.66，95%CI 0.60 - 0.72，p = 0.018）和对数转换后的ACR（AUC为0.63，95%CI 0.60 - 0.72，p = 0.0087）更有效。包含血压指标和糖尿病的6变量评分与4变量评分相比，鉴别能力并无更强。8变量评分与4变量评分相比表现相似（8变量评分的AUC：0.70，95%CI 0.64 - 0.76，p = 不优于eGFR < 15和20 mL/min/1.73 m。10%的阈值比eGFR < 30 mL/min/1.73 m更具特异性。
KFRE在进展为ESKD的患者与未进展患者之间具有高度鉴别性。4变量评分可能有助于对众多CKD 3期患者进行肾脏风险分层和转诊。相反，提议的用于建立血管通路或抢先移植的阈值并不优于单独的eGFR。
