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Validation of chronic kidney disease risk categorization system in Chinese patients with kidney disease: A cohort
Qingyan Liu1, Jicheng Lv2,3,4, Haixia Li1
1Department of Clinical Laboratory, Peking University First Hospital, Beijing, China.
Insights
Lower estimated glomerular filtration rate (eGFR) and higher proteinuria are significant risk factors for end-stage renal disease (ESRD) and all-cause mortality (ACM) in Chinese patients. The KDIGO guidelines effectively stratify CKD risk, improving patient categorization for adverse outcomes.
Area of Science:
- Nephrology
- Clinical Epidemiology
- Public Health
Background:
- Chronic kidney disease (CKD) affects millions globally, necessitating accurate risk stratification.
- The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines offer a risk assessment tool combining estimated glomerular filtration rate (eGFR) and proteinuria.
- Validating this system in diverse populations is crucial for clinical application.
Purpose of the Study:
- To evaluate the effectiveness of the KDIGO guidelines' risk stratification system.
- To assess the association between eGFR, proteinuria, and adverse outcomes (all-cause mortality [ACM] and end-stage renal disease [ESRD]).
- To determine if the KDIGO system accurately categorizes risk for CKD progression and mortality.
Main Methods:
- A cohort study involving 1219 participants.
- Measured predictors included eGFR and 24-hour urine protein excretion rate (PER).
- Adverse outcomes (ESRD, ACM) were tracked over a median of 4.6 years via regular visits, phone interviews, and electronic records.
Main Results:
- Lower eGFR and higher proteinuria demonstrated significant associations with increased risk of ESRD and ACM.
- Patients in the lowest eGFR category (15-29 mL/min/1.73 m²) had substantially higher adjusted hazard ratios for ESRD (29.8) and ACM (3.6).
- Higher PER (≥500 mg/24h) also correlated with elevated risks for ESRD (15.9) and ACM (3.9).
- The KDIGO risk categories showed a graded increase in risk for both ESRD and ACM (P < 0.001).
- Reclassification using KDIGO criteria improved risk prediction for ESRD and ACM events (net reclassification improvement of 33.3% and 30.2%, respectively).
Conclusions:
- Reduced eGFR and increased proteinuria are confirmed risk factors for ESRD and ACM in the studied Chinese population.
- The KDIGO guidelines risk stratification system effectively assigns patients to appropriate CKD risk categories.
- This validation supports the KDIGO system's utility in identifying high-risk individuals for adverse renal and mortality outcomes.
Aim:
To validate the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines risk stratification system based on the combination of estimated glomerular filtration rate (eGFR) and proteinuria.
Methods:
This was a cohort study. A total of 1219 study population were recruited. Estimated GFR and proteinuria measured by using 24 h urine protein excretion rate (PER) were predictors. Adverse outcomes included all-cause mortality (ACM) and end-stage renal disease (ESRD). Follow-up was done by regular visit, telephone interview and electronic medical records.
Results:
Over a median follow-up of 4.6 years, 153 (12.6%) and 43 (3.5%) patients experienced ESRD and ACM, respectively. On multivariable analysis, the adjusted hazard ratio for ESRD and ACM (compared with patients with eGFR > 60 mL/min per 1.7 m²) was of 29.8 and 3.6 for those with eGFR of 15-29 mL/min per 1.73 m², respectively. The adjusted hazard ratio for ESRD and ACM (compared with patients with PER < 150 mg/24h) was of 15.9 and 3.9 for those with PER > 500 mg/24h. Higher KDIGO guidelines risk categories (indicating lower eGFR or higher proteinuria) were associated with a graded increase in the risk for the ESRD (P < 0.001) and ACM (P < 0.001). Reclassification of KDIGO guidelines risk categories yielded net reclassification improvements for those with ESRD or ACM event (NRIevents ) of 33.3% or 30.2%.
Conclusion:
Lower eGFR and higher proteinuria are risk factors for ESRD and ACM in Chinese patients. The KDIGO guidelines risk categorization system assigned patients who went on to have the event to more appropriate CKD risk categories.
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