Progress in risk prediction for people with chronic kidney disease

Chronic kidney disease is common, but the associated risk of adverse outcomes is heterogeneous and methods for risk stratification are, therefore, required. We have reviewed recent progress in developing clinically applicable risk scores for people with chronic kidney disease.

Large epidemiological studies have confirmed that lower glomerular filtration rate and albuminuria are the most important risk factors for adverse outcomes in all populations studied. Ongoing research has identified several potentially important novel risk factors, including genetic factors, metabolomic factors, fibroblast growth factor 23, novel cardiovascular risk factors [CXC motif, ligand 12 (CXCL12) and ceruloplasmin], skin autofluorescence and inflammatory markers (serum-free light chains and circulating receptors for tumour necrosis factor). Several risk scores have been developed and one in particular (by Tangri et al.) performs well, uses variables commonly assessed in clinical practice and has been externally validated. Further studies are required to assess its performance in populations outside of secondary care and its usefulness in guiding decision making in clinical practice.

Although substantial progress has been made, the goal of achieving simple robust risk scores which are widely applicable and effective in guiding clinical decision making remains to be achieved.