Influence of mortality on estimating the risk of kidney failure in people with stage 4 CKD

Pietro Ravani, Marta Fiocco, Ping Liu, Robert R. Quinn, Brenda Hemmelgarn, Matthew James, Ngan Lam, Braden Manns, Matthew J. Oliver, Giovanni F.M. Strippoli, Marcello Tonelli

Onderzoeksoutput: Bijdrage aan tijdschriftArtikelpeer review

35 Citaten (Scopus)

Samenvatting

Background Most kidney failure risk calculators are based on methods that censor for death. Because mortality is high in people with severe, nondialysis-dependent CKD, censoring for death may overestimate their risk of kidney failure. Methods Using 2002–2014 population-based laboratory and administrative data for adults with stage 4 CKD in Alberta, Canada, we analyzed the time to the earliest of kidney failure, death, or censoring, using methods that censor for death and methods that treat death as a competing event factoring in age, sex, diabetes, cardiovascular disease, eGFR, and albuminuria. Stage 4 CKD was defined as a sustained eGFR of 15–30 ml/min per 1.73 m2. Results Of the 30,801 participants (106,447 patient-years at risk; mean age 77 years), 18% developed kidney failure and 53% died. The observed risk of the combined end point of death or kidney failure was 64% at 5 years and 87% at 10 years. By comparison, standard risk calculators that censored for death estimated these risks to be 76% at 5 years and .100% at 7.5 years. Censoring for death increasingly overestimated the risk of kidney failure over time from 7% at 5 years to 19% at 10 years, especially in people at higher risk of death. For example, the overestimation of 5-year absolute risk ranged from 1% in a woman without diabetes, cardiovascular disease, or albuminuria and with an eGFR of 25 ml/min per 1.73 m2 (9% versus 8%), to 27% in a man with diabetes, cardiovascular disease, albuminuria .300 mg/d, and an eGFR of 20 ml/min per 1.73 m2 (78% versus 51%). Conclusions Kidney failure risk calculators should account for death as a competing risk to increase their accuracy and utility for patients and providers.

Originele taal-2Engels
Pagina's (van-tot)2219-2227
Aantal pagina's9
TijdschriftJournal of the American Society of Nephrology
Volume30
Nummer van het tijdschrift11
DOI's
StatusGepubliceerd - 2019
Extern gepubliceerdJa

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