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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Clin+J+Am+Soc+Nephrol
2016 ; 11
(4
): 609-15
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External Validation of the Kidney Failure Risk Equation and Re-Calibration with
Addition of Ultrasound Parameters
#MMPMID26787778
Lennartz CS
; Pickering JW
; Seiler-Mußler S
; Bauer L
; Untersteller K
; Emrich IE
; Zawada AM
; Radermacher J
; Tangri N
; Fliser D
; Heine GH
Clin J Am Soc Nephrol
2016[Apr]; 11
(4
): 609-15
PMID26787778
show ga
BACKGROUND AND OBJECTIVES: Progression of CKD toward ESRD is heterogeneous. The
Kidney Failure Risk Equation (KFRE) was developed to identify CKD patients at
high risk of ESRD. We aimed to externally validate KFRE and to test whether the
addition of predefined Duplex ultrasound markers - renal resistive index (RRI) or
difference of resistive indices in spleen and kidney (DI-RISK) - improved ESRD
prediction. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The prospective
Cardiovascular and Renal Outcome in CKD 2-4 Patients-The Fourth Homburg
evaluation (CARE FOR HOMe) study recruits CKD stage G2-G4 patients referred to a
tertiary referral center for nephrologic care. Four hundred three CARE FOR HOMe
participants enrolled between 2008 and 2012 had available RRI measurements at
study inclusion; they were subsequently followed for a mean of 4.4±1.6 years.
This subcohort was used to validate KFRE and to assess the added value of the
ultrasound markers (new models KFRE+RRI and KFRE+DI-RISK). Model performance was
assessed by log-likelihood ratio test, c-statistic, integrated discrimination
improvement metrics (for study participants without subsequent ESRD [IDI No ESRD]
and for patients with ESRD [IDI ESRD]), and calibration plots. If either new
model improved on KFRE, we determined to validate it in an independent cohort of
162 CKD patients. RESULTS: KFRE predicted ESRD in CARE FOR HOMe participants with
a c-statistic of 0.91 (95% confidence interval, 0.83 to 0.99). Adding RRI
improved the KFRE model (P<0.001), and the KFRE+RRI model was well calibrated;
however, the c-statistic (0.91 [0.83-1.00]) was similar, and overall sensitivity
(IDI No ESRD=0.05 [0.00-0.10]) or overall specificity (IDI ESRD=0.00 [0.00-0.01])
did not improve. Adding DI-RISK did not improve the KRFE model. In the external
validation cohort, we confirmed that the KFRE+RRI model did not outperform KFRE.
CONCLUSIONS: Routine Duplex examinations among CKD patients did not improve risk
prediction for progression to ESRD beyond a validated equation.
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