Centre for Public Health, Queen's University of Belfast, Belfast, BT12 6AB, Northern Ireland.
Regional Nephrology Unit, Belfast City Hospital, Lisburn Road, BT9 7BA, Belfast, Northern Ireland.
Syst Rev. 2024 May 4;13(1):122. doi: 10.1186/s13643-024-02543-y.
IgA nephropathy (IgAN) is a common cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD). Outcomes are highly variable and predicting risk of disease progression at an individual level is challenging. Accurate risk stratification is important to identify individuals most likely to benefit from treatment. The Kidney Failure Risk Equation (KFRE) has been extensively validated in CKD populations and predicts the risk of ESRD at 2 and 5 years using non-invasive tests; however, its predictive performance in IgAN is unknown. The Oxford classification (OC) describes pathological features demonstrated on renal biopsy that are associated with adverse clinical outcomes that may also inform prognosis. The objective of this systematic review is to compare the KFRE with the OC in determining prognosis in IgAN.
A systematic review will be conducted and reported in line with PRISMA guidelines (PRISMA-P checklist attached as Additional file 1). Inclusion criteria will be cohort studies that apply the KFRE or OC to determine the risk of CKD progression or ESRD in individuals with IgAN. Multiple databases will be searched in duplicate to identify relevant studies, which will be screened first by title, then by abstract and then by full-text analysis. Results will be collated for comparison. Risk of bias and confidence assessments will be conducted independently by two reviewers, with a third reviewer available if required.
Identifying individuals at the highest risk of progression to ESRD is challenging in IgAN, due to the heterogeneity of clinical outcomes. Risk prediction tools have been developed to guide clinicians; however, it is imperative that these aids are accurate and reproducible. The OC is based on observations made by specialist renal pathologists and may be open to observer bias, therefore the utility of prediction models incorporating this classification may be diminished, particularly as in the future novel biomarkers may be incorporated into clinical practice.
PROSPERO CRD42022364569.
IgA 肾病（IgAN）是慢性肾脏病（CKD）和终末期肾病（ESRD）的常见病因。结局差异很大，在个体水平预测疾病进展的风险具有挑战性。准确的风险分层对于确定最有可能从治疗中获益的个体非常重要。肾衰竭风险方程（KFRE）已在 CKD 人群中得到广泛验证，可使用非侵入性检查预测 2 年和 5 年时 ESRD 的风险；然而，其在 IgAN 中的预测性能尚不清楚。牛津分类（OC）描述了肾活检中显示的与不良临床结局相关的病理特征，这些特征可能也有助于预后判断。本系统评价的目的是比较 KFRE 和 OC 在确定 IgAN 预后方面的作用。
将按照 PRISMA 指南（附加文件 1 中附有 PRISMA-P 清单）进行系统评价并报告。纳入标准为应用 KFRE 或 OC 确定 IgAN 患者 CKD 进展或 ESRD 风险的队列研究。将重复进行多项数据库检索以识别相关研究，首先根据标题筛选，然后根据摘要筛选，最后根据全文分析筛选。将结果进行整理比较。风险偏倚和置信度评估将由两名评审员独立进行，如果需要，将有第三名评审员参与。
由于 IgAN 临床结局的异质性，确定进展为 ESRD 的风险最高的个体具有挑战性。已经开发了风险预测工具来指导临床医生；然而，这些工具必须准确且可重复。OC 基于肾脏病理学家的观察结果，可能存在观察者偏倚，因此纳入该分类的预测模型的实用性可能会降低，尤其是因为未来可能会将新型生物标志物纳入临床实践。
PROSPERO CRD42022364569。
