Predicting the risk of Chronic Kidney Disease in Men and Women in England and Wales: prospective derivation and external validation of the QKidneyScores

Division of Primary Care, 13th floor, Tower Building, University Park, Nottingham NG2 7RD, UK.
BMC Family Practice (Impact Factor: 1.67). 06/2010; 11(1):49. DOI: 10.1186/1471-2296-11-49
Source: PubMed


Chronic Kidney Disease is a major cause of morbidity and interventions now exist which can reduce risk. We sought to develop and validate two new risk algorithms (the QKidney Scores) for estimating (a) the individual 5 year risk of moderate-severe CKD and (b) the individual 5 year risk of developing End Stage Kidney Failure in a primary care population.
We conducted a prospective open cohort study using data from 368 QResearch general practices to develop the scores. We validated the scores using two separate sets of practices--188 separate QResearch practices and 364 practices contributing to the THIN database.We studied 775,091 women and 799,658 men aged 35-74 years in the QResearch derivation cohort, who contributed 4,068,643 and 4,121,926 person-years of observation respectively.We had two main outcomes (a) moderate-severe CKD (defined as the first evidence of CKD based on the earliest of any of the following: kidney transplant; kidney dialysis; diagnosis of nephropathy; persistent proteinuria; or glomerular filtration rate of < 45 mL/min) and (b) End Stage Kidney Failure.We derived separate risk equations for men and women. We calculated measures of calibration and discrimination using the two separate validation cohorts.
Our final model for moderate-severe CKD included: age, ethnicity, deprivation, smoking, BMI, systolic blood pressure, diabetes, rheumatoid arthritis, cardiovascular disease, treated hypertension, congestive cardiac failure; peripheral vascular disease, NSAID use and family history of kidney disease. In addition, it included SLE and kidney stones in women. The final model for End Stage Kidney Failure was similar except it did not include NSAID use.Each risk prediction algorithms performed well across all measures in both validation cohorts. For the THIN cohort, the model to predict moderate-severe CKD explained 56.38% of the total variation in women and 57.49% for men. The D statistic values were high with values of 2.33 for women and 2.38 for men. The ROC statistic was 0.875 for women and 0.876 for men.
These new algorithms have the potential to identify high risk patients who might benefit from more detailed assessment, closer monitoring or interventions to reduce their risk.

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Available from: Carol Coupland, Jun 02, 2014
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    • "In spite of that, posttreatment recurrence rates are high, and the recurrence rate of nephrolithiasis is expected to exceed 30% within 10 years of an initial stone event [5]. Recent studies showed nephrolithiasis and related obstruction as risk factors to chronic kidney disease (CKD), and CKD was twofold higher among individuals with history of kidney stones [6] [7]. Until now, nephrolithiasis could only be diagnosed by imaging examinations, however, the use of which becomes less when the stone is <5 mm. "
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    • "Compared with people without diabetes and even after adjusting for other risk factors, those with type 2 diabetes have three to five times the risk of developing end-stage renal disease (ESRD) resulting in dialysis, renal transplantation, or early mortality (1). Diabetes has become the leading cause of ESRD in many countries (2), with certain ethnic groups having much higher rates than others (3,4). "
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    ABSTRACT: OBJECTIVE Diabetes has become the leading cause of end-stage renal disease (ESRD). Renal risk stratification could assist in earlier identification and targeted prevention. This study aimed to derive risk models to predict ESRD events in type 2 diabetes in primary care.RESEARCH DESIGN AND METHODS The nationwide derivation cohort included adults with type 2 diabetes from the New Zealand Diabetes Cohort Study initially assessed 2000-2006 and followed until December 2010, excluding those with pre-existing ESRD. The outcome was fatal or nonfatal ESRD event (peritoneal dialysis or hemodialysis for ESRD, renal transplantation, or death from ESRD). Risk models were developed using Cox proportional hazards models, and their performance was assessed in a separate validation cohort.RESULTSThe derivation cohort included 25,736 individuals followed for up to 11 years (180,497 person-years; 86% followed for ≥5 years). At baseline, mean age was 62 years, median diabetes duration 5 years, median HbA1c 7.2% (55 mmol/mol), 37% had albuminuria, and median estimated glomerular filtration rate (eGFR) was 77 mL/min/1.73 m(2). There were 637 ESRD events (2.5%) during follow-up. Models that included sex, ethnicity, age, diabetes duration, albuminuria, serum creatinine, systolic blood pressure, HbA1c, smoking status, and previous cardiovascular disease status performed well with good discrimination and calibration in the derivation cohort and the validation cohort (n = 5,877) (C-statistics 0.89-0.92), improving predictive performance compared with previous models.CONCLUSIONS These 5-year renal risk models performed very well in two large primary care populations with type 2 diabetes. More accurate risk stratification could facilitate earlier intervention than using eGFR and/or albuminuria alone.
    Full-text · Article · Jun 2013 · Diabetes care
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    • "A truly protective effect of Hg appears unlikely. Instead, it can be speculated that there may be confounding by a healthy lifestyle, including fish consumption and with a low burden of other risk factors [45] such as low socio-economic status [38,46,47]. An alternative, and even more speculative interpretation, is a protective effect of long-chain omega-3 polyunsaturated fatty acids (PUFAs) from fish. "
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    ABSTRACT: Background Cadmium (Cd), lead (Pb), and mercury (Hg) cause toxicological renal effects, but the clinical relevance at low-level exposures in general populations is unclear. The objective of this study is to assess the risk of developing end-stage renal disease in relation to Cd, Pb, and Hg exposure. Methods A total of 118 cases who later in life developed end-stage renal disease, and 378 matched (sex, age, area, and time of blood sampling) referents were identified among participants in two population-based prospective cohorts (130,000 individuals). Cd, Pb, and Hg concentrations were determined in prospectively collected samples. Results Erythrocyte lead was associated with an increased risk of developing end-stage renal disease (mean in cases 76 μg/L; odds ratio (OR) 1.54 for an interquartile range increase, 95% confidence interval (CI) 1.18-2.00), while erythrocyte mercury was negatively associated (2.4 μg/L; OR 0.75 for an interquartile range increase, CI 0.56-0.99). For erythrocyte cadmium, the OR of developing end-stage renal disease was 1.15 for an interquartile range increase (CI 0.99-1.34; mean Ery-Cd among cases: 1.3 μg/L). The associations for erythrocyte lead and erythrocyte mercury, but not for erythrocyte cadmium, remained after adjusting for the other two metals, smoking, BMI, diabetes, and hypertension. Gender-specific analyses showed that men carried almost all of the erythrocyte lead and erythrocyte cadmium associated risks. Conclusions Erythrocyte lead is associated with end-stage renal disease but further studies are needed to evaluate causality. Gender-specific analyses suggest potential differences in susceptibility or in exposure biomarker reliability.
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