Investigation of end-stage kidney disease risk prediction in an ethnically diverse cohort of people with type 2 diabetes: use of kidney failure risk equation
Authors' conclusion
Although derived for predicting KF, KFRE also demonstrated good discrimination for ESKD outcome. Further studies are needed to identify variables/biomarkers that may improve KFRE's performance/calibration and to aid the development of other predictive models to enable early identification of people at risk of advanced stages of CKD prior to onset of KF.
Study context
- Population
- People with T2D and chronic kidney disease (CKD) (estimated glomerular filtration rate (eGFR) median (range) 48 (15–59) mL/min/1.73 m²), 30% women, 41% African-Caribbean, 45% Caucasian, two hospitals in Londonmedian follow-up 10.2 years
- Participants
- 7,296 people
- Outcome
- ESKD: eGFR <10 mL/min/1.73 m²; KFRE discrimination by C-index
- Follow-up
- 2 and 5 years
Methodological detailstwo hospitals in London, external validation of KFRE
- Two hospitals in London
- External validation of KFRE
Performance
As reported in the abstract
KFRE discrimination for primary ESKD endpoint (eGFR <10)
- Concordance index (C-index) at 2 years
- 0.842 (95% CI 0.836 to 0.848)
- C-index at 5 years
- 0.816 (95% CI 0.812 to 0.820)
- Reached end-stage kidney disease (ESKD) primary event, overall
- 746 (10.2%)
- Reached ESKD primary event over 2 years
- 135 (1.9%)
- Reached ESKD primary event over 5 years
- 339 (4.5%)
Secondary outcomes
Secondary endpoint eGFR <15 mL/min/1.73 m²
- Reached secondary endpoint, overall
- 1130 (15.5%)
- Reached secondary endpoint over 2 years
- 270 (3.7%)
- Reached secondary endpoint over 5 years
- 547 (7.5%)
- C-index at 2 years (0.839-0.847)
- 0.843
- C-index at 5 years (0.798-0.804)
- 0.801
Calibration
- KFRE performed more optimally with primary endpoint, calibration metrics enhanced vs secondary endpoint
- 50%
- KFRE recalibration improved integrated calibration index (ICI)
- by 50%
- KFRE recalibration improved E90
- by more than 78%
Original publication
Investigation of end-stage kidney disease risk prediction in an ethnically diverse cohort of people with type 2 diabetes: use of kidney failure risk equation. BMJ Open Diabetes Res Care. Published 13 September 2024. doi:10.
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