Larrarte C, Vesga J, Ardila F, Aldana A, Perea D, Sanabria M
Baxter Renal Care Services, Bucaramanga, Colombia.
Baxter Renal Care Services-Latin America, Bogotá, Colombia.
Int J Nephrol. 2024 Feb 17;2024:1282664. doi: 10.1155/2024/1282664. eCollection 2024.
Chronic kidney disease prevention programs must identify patients at risk of early progression to provide better treatment and prolong kidney replacement therapy-free survival. Risk equations have been developed and validated in cohorts outside of Colombia, so this study aims to evaluate the discrimination and calibration of the four-variable kidney failure risk equation in a Colombian population where it has yet to be validated.
External validation study of a kidney failure risk equation using a historical cohort of patients with CKD stages 3, 4, and 5, adults without a history of dialysis or kidney transplantation with a two-year follow-up, belonging to the Baxter Renal Care Services Colombia network. The discriminatory capacity of the model was evaluated by the concordance index using Harrell's C statistic, and the time-dependent area under the receiver operating characteristic (ROC) curve was estimated using the nearest neighbor method, as well as the optimal cut-off point for sensitivity and specificity. Calibration was determined by the degree of agreement between the observed outcome and the probabilities predicted by the model using the Hosmer-Lemeshow statistic.
A total of 5,477 patients were included, with a mean age of 72 years, 36.4% diabetic, and a mean baseline eGFR of 36 ml/min/1.73 m. The rate of dialysis initiation was three events per 100 patient-years, 95% CI (2.9-3.6). The optimal cutoff for sensitivity was 0.94, for specificity, 0.76, and the area under the ROC curve was 0.92. Harrell's C-statistic was 0.88 for the total population, 0.88 for diabetic patients, and 0.93 for those 65 years or older. The validation of the model showed good calibration.
In this Colombian cohort, the four-variable KFRE with a two-year prediction horizon has excellent calibration and discrimination, and its use in the care of CKD Colombian patients is recommended.
慢性肾脏病预防项目必须识别有早期进展风险的患者，以便提供更好的治疗并延长无肾脏替代治疗的生存期。风险方程已在哥伦比亚以外的队列中开发并验证，因此本研究旨在评估四变量肾衰竭风险方程在尚未验证的哥伦比亚人群中的辨别力和校准情况。
对肾衰竭风险方程进行外部验证研究，使用来自哥伦比亚百特肾脏护理服务网络的慢性肾脏病3、4、5期成年患者的历史队列，这些患者无透析或肾移植史，随访两年。使用Harrell's C统计量通过一致性指数评估模型的辨别能力，使用最近邻法估计受试者工作特征（ROC）曲线下的时间依赖性面积，以及敏感性和特异性的最佳截断点。使用Hosmer-Lemeshow统计量通过观察到的结果与模型预测的概率之间的一致程度来确定校准情况。
共纳入5477例患者，平均年龄72岁，36.4%为糖尿病患者，平均基线估算肾小球滤过率（eGFR）为36 ml/min/1.73 m²。透析起始率为每100患者年3例事件，95%置信区间（2.9 - 3.6）。敏感性的最佳截断值为0.94，特异性为0.76，ROC曲线下面积为0.92。总体人群的Harrell's C统计量为0.88，糖尿病患者为0.88，65岁及以上患者为0.93。模型验证显示校准良好。
在这个哥伦比亚队列中，具有两年预测期的四变量KFRE具有出色的校准和辨别力，建议将其用于哥伦比亚慢性肾脏病患者的护理。
