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2015 ; 26
(6
): 1434-42
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Evaluating risk of ESRD in the urban poor
#MMPMID25475746
Maziarz M
; Black RA
; Fong CT
; Himmelfarb J
; Chertow GM
; Hall YN
J Am Soc Nephrol
2015[Jun]; 26
(6
): 1434-42
PMID25475746
show ga
The capacity of risk prediction to guide management of CKD in underserved health
settings is unknown. We conducted a retrospective cohort study of 28,779 adults
with nondialysis-requiring CKD who received health care in two large safety net
health systems during 1996-2009 and were followed for ESRD through September of
2011. We developed and evaluated the performance of ESRD risk prediction models
using recently proposed criteria designed to inform population health approaches
to disease management: proportion of cases followed and proportion that needs to
be followed. Overall, 1730 persons progressed to ESRD during follow-up (median
follow-up=6.6 years). ESRD risk for time frames up to 5 years was highly
concentrated among relatively few individuals. A predictive model using five
common variables (age, sex, race, eGFR, and dipstick proteinuria) performed
similarly to more complex models incorporating extensive sociodemographic and
clinical data. Using this model, 80% of individuals who eventually developed ESRD
were among the 5% of cohort members at the highest estimated risk for ESRD at 1
year. Similarly, a program that followed 8% and 13% of individuals at the highest
ESRD risk would have included 80% of those who eventually progressed to ESRD at 3
and 5 years, respectively. In this underserved health setting, a simple
five-variable model accurately predicts most cases of ESRD that develop within 5
years. Applying risk prediction using a population health approach may improve
CKD surveillance and management of vulnerable groups by directing resources to a
small subpopulation at highest risk for progressing to ESRD.
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