根据慢性肾脏病CKD-CAREMEAU队列中患者的糖尿病状态，评估肾衰竭风险方程的性能。

Performance of the Kidney Failure Risk Equation according to diabetic status in the CKD-CAREMEAU cohort of patients with chronic kidney disease.

作者信息

Prouvot Julien, Reboul Pascal, Ahmadpoor Pedram, Clemmer Edouard, Gerbal Marion, Garo Florian, Cariou Sylvain, Pambrun Emilie, Messikh Ziyad, Moranne Olivier

机构信息

Service Néphrologie Dialyse Aphérèse, Centre Hospitalier Universitaire de Nîmes, Nîmes, France.

IDESP, Université de Montpellier, Montpellier, France.

出版信息

J Nephrol. 2025 Jun 19. doi: 10.1007/s40620-025-02286-6.

DOI:10.1007/s40620-025-02286-6

PMID:40536612

Abstract

BACKGROUND

The Kidney Failure Risk Equation (KFRE) estimates the risk of kidney replacement therapy (KRT) at 5 years. Patients with diabetes mellitus are at high risk of KRT and death, a competing event. This study assesses the performance of the 5-year KFRE in patients with diabetes mellitus, compared to non-diabetic patients and considering age, in a cohort of patients evaluated by a nephrologist at a tertiary care center.

METHODS

The CKD-CAREMEAU cohort included all patients who visited a nephrologist for chronic kidney disease (CKD) before KRT between 2008 and 2017. The 5-year KFRE was calculated for each patient, based on their baseline characteristics. The study evaluated performance regarding discrimination and calibration, taking the patient's diabetic status and age into account.

RESULTS

The study included 2935 patients with a median age of 73 [65-80] years, 1800 of whom were men (61%), and 1249 (43%) who were affected by diabetes. The incidence of KRT was higher in diabetic patients (167 (13%)) than in non-diabetic patients (184 (11%))(p = 0.04). Additionally, the death rate within five years after inclusion was not statistically higher for diabetic patients (351 (28%)) than non-diabetic patients (443 (26%))(p = 0.3). Diabetic status affected neither discrimination nor calibration. However, the equation overestimated the risk for higher-risk patients, especially among the elderly.

CONCLUSIONS

Our study found no difference in the 5-year KFRE performance between diabetic and non-diabetic patients. However, performance was worse for patients over 75 years old.

摘要

背景

肾衰竭风险方程（KFRE）可估计5年内进行肾脏替代治疗（KRT）的风险。糖尿病患者发生KRT和死亡（一种竞争事件）的风险很高。本研究在一家三级医疗中心由肾病专家评估的患者队列中，评估了5年KFRE在糖尿病患者中的表现，与非糖尿病患者进行比较，并考虑了年龄因素。

方法

CKD-CAREMEAU队列包括2008年至2017年期间在接受KRT之前因慢性肾脏病（CKD）就诊于肾病专家的所有患者。根据每位患者的基线特征计算其5年KFRE。该研究在考虑患者糖尿病状态和年龄的情况下，评估了鉴别和校准方面的表现。

结果

该研究纳入了2935例患者，中位年龄为73[65-80]岁，其中1800例为男性（61%），1249例（43%）患有糖尿病。糖尿病患者的KRT发生率（167例（13%））高于非糖尿病患者（184例（11%））（p = 0.04）。此外，纳入后五年内糖尿病患者的死亡率（351例（28%））在统计学上并不高于非糖尿病患者（443例（26%））（p = 0.3）。糖尿病状态对鉴别和校准均无影响。然而，该方程高估了高危患者的风险，尤其是老年人。