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Kidney function and risk triage in adults: threshold values and hierarchical importance
Robert N Foley1, Changchun Wang, Jon J Snyder
1United States Renal System, Minneapolis, Minnesota 55404, USA. rfoley@usrds.org
Kidney International
|August 20, 2010
Summary
Identifying optimal kidney function thresholds for predicting short-term mortality is crucial. Albumin-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) show strong prognostic value, potentially outperforming traditional risk factors.
Area of Science:
- Nephrology
- Public Health
- Epidemiology
Background:
- Kidney function measures like eGFR and ACR are vital for assessing kidney health.
- Identifying thresholds for these measures can aid in predicting mortality risk.
- Traditional risk factors are well-established, but novel markers may offer improved prognostic capabilities.
Purpose of the Study:
- To determine threshold values for kidney function measures (eGFR, ACR) that best predict short-term mortality.
- To identify specific population segments where these thresholds are most applicable.
- To rank the hierarchical importance of eGFR and ACR thresholds against other classic risk factors.
Main Methods:
- Retrospective analysis of NHANES III participants (1988-1994, followed through 2000).
- Identification of eGFR and ACR thresholds maximizing sensitivity and specificity for predicting death.
- Use of classification trees, both with and without dichotomizing variables, to assess risk factor hierarchy.
Main Results:
- Optimal eGFR and ACR thresholds demonstrated superior prognostic discrimination compared to LDL cholesterol and fasting blood glucose.
- In classification trees, ACR and eGFR emerged as significant predictors, sometimes ranking higher than traditional factors like BMI, smoking, and LDL.
- The albumin-creatinine ratio and eGFR showed efficiency comparable to established risk factors for survival-based clinical triage.
Conclusions:
- Albumin-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) are highly effective in predicting short-term mortality.
- These kidney function markers may serve as efficient tools for clinical triage, potentially surpassing the utility of some traditional risk factors.
- Further research into the clinical application of ACR and eGFR thresholds for survival prediction is warranted.
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