Wanner Christoph, Schuchhardt Johannes, Bauer Chris, Brinker Meike, Kleinjung Frank, Vaitsiakhovich Tatsiana
Medizinische Klinik Und Poliklinik 1, Schwerpunkt Nephrologie, Universitätsklinik Würzburg, Würzburg, Germany.
MicroDiscovery GmbH, Berlin, Germany.
BMC Nephrol. 2025 Jan 7;26(1):8. doi: 10.1186/s12882-024-03906-2.
Chronic kidney disease (CKD) is a global health problem, affecting over 840 million individuals. CKD is linked to higher mortality and morbidity, partially mediated by higher cardiovascular risk and worsening kidney function. This study aimed to identify risk factors and develop risk prediction models for selected cardiorenal clinical outcomes in patients with non-diabetic CKD.
The study included adults with non-diabetic CKD (stages 3 or 4) from the Optum® Clinformatics® Data Mart US healthcare claims database. Three outcomes were investigated: composite outcome of kidney failure/need for dialysis, hospitalization for heart failure, and worsening of CKD from baseline. Multivariable time-to-first-event risk prediction models were developed for each outcome using swarm intelligence methods. Model discrimination was demonstrated by stratifying cohorts into five risk groups and presenting the separation between Kaplan-Meier curves for these groups.
The prediction model for kidney failure/need for dialysis revealed stage 4 CKD (hazard ratio [HR] = 2.05, 95% confidence interval [CI] = 2.01-2.08), severely increased albuminuria-A3 (HR = 1.58, 95% CI = 1.45-1.72), metastatic solid tumor (HR = 1.58, 95% CI = 1.52-1.64), anemia (HR = 1.42, 95% CI = 1.41-1.44), and proteinuria (HR = 1.40, 95% CI = 1.36-1.43) as the strongest risk factors. History of heart failure (HR = 2.42, 95% CI = 2.37-2.48), use of loop diuretics (HR = 1.65, 95% CI = 1.62-1.69), severely increased albuminuria-A3 (HR = 1.55, 95% CI = 1.33-1.80), atrial fibrillation or flutter (HR = 1.53, 95% CI = 1.50-1.56), and stage 4 CKD (HR = 1.48, 95% CI = 1.44-1.52) were the greatest risk factors for hospitalization for heart failure. Stage 4 CKD (HR = 2.90, 95% CI = 2.83-2.97), severely increased albuminuria-A3 (HR = 2.30, 95% CI = 2.09-2.53), stage 3 CKD (HR = 1.74, 95% CI = 1.71-1.77), polycystic kidney disease (HR = 1.68, 95% CI = 1.60-1.76), and proteinuria (HR = 1.55, 95% CI = 1.50-1.60) were the main risk factors for worsening of CKD stage from baseline. Female gender and normal-to-mildly increased albuminuria-A1 were found to be associated with lower risk in all prediction models for patients with non-diabetic CKD stage 3 or 4.
Risk prediction models to identify individuals with non-diabetic CKD at high risk of adverse cardiorenal outcomes have been developed using routinely collected data from a US healthcare claims database. The models may have potential for broad clinical applications in patient care.
慢性肾脏病（CKD）是一个全球性的健康问题，影响着超过8.4亿人。CKD与更高的死亡率和发病率相关，部分原因是心血管风险增加和肾功能恶化。本研究旨在确定非糖尿病CKD患者特定心肾临床结局的危险因素并建立风险预测模型。
该研究纳入了来自Optum® Clinformatics® Data Mart美国医疗保健索赔数据库的非糖尿病CKD（3期或4期）成人患者。研究了三个结局：肾衰竭/透析需求的复合结局、因心力衰竭住院以及CKD自基线起的恶化。使用群体智能方法为每个结局建立多变量首次事件发生时间风险预测模型。通过将队列分层为五个风险组并展示这些组的Kaplan-Meier曲线之间的分离来证明模型的区分度。
肾衰竭/透析需求的预测模型显示，4期CKD（风险比[HR]=2.05，95%置信区间[CI]=2.01-2.08）、严重蛋白尿增加-A3（HR=1.58，95%CI=1.45-1.72）、转移性实体瘤（HR=1.58，95%CI=1.52-1.64）、贫血（HR=1.42，95%CI=1.41-1.44）和蛋白尿（HR=1.40，95%CI=1.36-1.43）是最强的危险因素。心力衰竭病史（HR=2.42，95%CI=2.37-2.48）、使用袢利尿剂（HR=1.65，95%CI=1.62-1.69）、严重蛋白尿增加-A3（HR=1.55，95%CI=1.33-1.80）、心房颤动或扑动（HR=1.53，95%CI=1.50-1.56）和4期CKD（HR=1.48，95%CI=1.44-1.52）是因心力衰竭住院的最大危险因素。4期CKD（HR=2.90，95%CI=2.83-2.97）、严重蛋白尿增加-A3（HR=2.30，95%CI=2.09-2.53）、3期CKD（HR=1.74，95%CI=1.71-1.77）、多囊肾病（HR=1.68，95%CI=1.60-1.76）和蛋白尿（HR=1.55，95%CI=1.50-1.60）是CKD分期自基线起恶化的主要危险因素。在所有针对非糖尿病CKD 3期或4期患者的预测模型中，发现女性性别以及正常至轻度蛋白尿增加-A1与较低风险相关。
利用美国医疗保健索赔数据库中常规收集的数据，已建立了风险预测模型，以识别具有不良心肾结局高风险的非糖尿病CKD患者。这些模型可能在患者护理中具有广泛的临床应用潜力。
