腎不全のリスクを予測する方程式の精度に関する多国間評価:メタ解析
Navdeep Tangri1, Morgan E Grams2, Andrew S Levey3
1Department of Medicine, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Canada2Department of Community Health Sciences, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Canada.
JAMA
|January 13, 2016
まとめ
腎不全のリスクの方程式は,世界的に高い精度を示しています. 慢性腎臓病 (CKD) の進行の予測を改善するために,北米以外の集団では,校正の調整が必要になる可能性があります.
科学分野:
- 腎臓科
- 流行病学について
- バイオ統計学
背景:
- 慢性腎臓病 (CKD) の進行リスクのある患者の特定は,効果的な腎臓の治療に不可欠です.
- 既存の腎不全リスク方程式は,腎臓学者が管理していない様々な世界的な集団とCKD患者で検証する必要があります.
研究 の 目的:
- 既定の腎不全リスク方程式の正確さを,様々な地理的地域と患者集団で評価する.
- 各参加者のデータメタ解析を通じて,これらのリスク予測ツールの地域的な校正の必要性を評価する.
主な方法:
- 30カ国以上からCKD3〜5段階の721,357人の参加者を含む31のコホートにおける個々の参加者のデータメタ解析.
- 1982年から2014年の間に収集されたデータは,コホート固有の危険比率を推定するために分析され,統合された腎不全リスク方程式を形成しました.
主要な成果:
- 原始的な腎不全リスク方程式は,さまざまなコホートにおいて優れた差別性を示した (C統計は2年後に0. 90で,5年後に0. 88).
- 北米では校正が適切であったが,北米以外のコホートではリスクが過大評価された.これらの地域では校正因子を追加することで精度が向上した.
結論:
- カナダで開発された腎不全リスク方程式は,高い差別性とグローバルな文脈での適切な校正を示しています.
- 北米以外の特定の集団における腎不全リスクの予測の正確性を高めるには,地域的な校正因子が必要である.
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