External Validation of the Kidney Failure Risk Equation and Re-Calibration with Addition of Ultrasound Parameters.

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. 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. 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. Routine Duplex examinations among CKD patients did not improve risk prediction for progression to ESRD beyond a validated equation.

Lennartz CS ，Pickering JW ，Seiler-Mußler S ，Bauer L ，Untersteller K ，Emrich IE ，Zawada AM ，Radermacher J ，Tangri N ，Fliser D ，Heine GH ... -  《-》

The Kidney Failure Risk Equation for prediction of end stage renal disease in UK primary care: An external validation and clinical impact projection cohort study.

Major RW ，Shepherd D ，Medcalf JF ，Xu G ，Gray LJ ，Brunskill NJ ... -  《-》

Value of adding the renal pathological score to the kidney failure risk equation in advanced diabetic nephropathy.

Yamanouchi M ，Hoshino J ，Ubara Y ，Takaichi K ，Kinowaki K ，Fujii T ，Ohashi K ，Mise K ，Toyama T ，Hara A ，Kitagawa K ，Shimizu M ，Furuichi K ，Wada T ... -  《PLoS One》

Use of the Kidney Failure Risk Equation to Determine the Risk of Progression to End-stage Renal Disease in Children With Chronic Kidney Disease.

Winnicki E ，McCulloch CE ，Mitsnefes MM ，Furth SL ，Warady BA ，Ku E ... -  《-》

A validation study of the kidney failure risk equation in advanced chronic kidney disease according to disease aetiology with evaluation of discrimination, calibration and clinical utility.

Ali I ，Donne RL ，Kalra PA 《BMC Nephrology》