Predicting Kidney Failure, Cardiovascular Disease and Death in Advanced CKD Patients

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Geriatrics

Background:

• Predicting outcomes in advanced chronic kidney disease (CKD) is crucial for patient management.
• Kidney replacement therapy (KRT), cardiovascular events, and mortality are key concerns for CKD G4+ patients.
• Clinical tools are needed to guide timely interventions, such as vascular access placement.

Purpose of the Study:

• To externally validate a CKD G4+ risk calculator for predicting KRT, cardiovascular events, and death.
• To assess the clinical utility of the risk calculator in guiding vascular access placement decisions.

Main Methods:

• Validation in 1517 advanced CKD patients (age ≥65) from the European Quality (EQUAL) study.
• Performance assessment using discrimination (C-statistics) and calibration.
• Evaluation of clinical utility for vascular access referral using decision curve analysis (DCA).

Main Results:

• The model demonstrated good discrimination for KRT (2-year C=0.74) and death after KRT (2-year C=0.76).
• Poorer discrimination was observed for cardiovascular events (2-year C=0.70) and overall death (2-year C=0.61).
• Decision curves suggested the model could reduce unnecessary arteriovenous fistula (AVF) placements compared to eGFR thresholds.

Conclusions:

• The CKD G4+ risk calculator exhibits moderate to good predictive performance in older, nephrology-referred advanced CKD patients.
• Utilizing this model for vascular access referral guidance shows potential to decrease unnecessary surgeries.
• Further application of risk prediction models can aid in optimizing care pathways for advanced CKD.