两个方程的CKD阶段特定实用性,用于预测ESKD的一年风险
Sijie Zheng1,2,3, Rishi V Parikh2, Thida C Tan2
1Department of Nephrology, Kaiser Permanente Oakland Medical Center, Oakland, California, United States of America.
PloS one
|November 1, 2023
概括
衰竭风险方程 (KFRE) 和凯泽永久西北 (KPNW) 模型显示,预测慢性病患者1年末期病 (ESKD) 风险的准确性中等. 这些模型对于第四阶段CKD更可靠,表明需要改进,个性化预测工具.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 公共卫生 公共卫生
- 生物统计学 生物统计学
背景情况:
- 慢性病 (CKD) 影响着大量人群,因此需要准确预测进展到末期病 (ESKD) 的风险.
- 现有的模型,如衰竭风险方程 (KFRE) 和凯泽永久西北 (KPNW) 模型,旨在预测2-5年内ESKD风险.
- 评估这些模型在各种CKD人群中进行短期 (1年) 预测对于临床决策至关重要.
研究的目的:
- 评估KFRE和KPNW模型对ESKD的一年风险的预测效用.
- 评估这些模型在CKD不同阶段 (3-5阶段) 的区分和校准.
- 确定这些模型在当代,种族多样化的CKD人群中的适用性.
主要方法:
- 从凯泽永久医院北加利福尼亚州 (2008-2015) 的108,091名成年CKD患者 (3-5阶段) 的回顾性队列研究.
- 通过2016年9月确定ESKD的出现.
- 计算特定阶段模型歧视 (c-统计) 和对KFRE和KPNW方程进行校准.
主要成果:
- 对于CKD第3阶段和第5阶段,KFRE显示了适度的歧视 (c=0.76),但对于第4阶段 (c=0.86) 则显示出了极好的歧视.
- 校准对于CKD 3-4阶段是好的,但对于KFRE的5阶段是不理想的.
- 该KPNW模型显示了类似于KFRE的校准,但对跨越CKD阶段的1年ESKD预测的整体校准更差.
结论:
- 两种KFRE和KPNW模型都不足以预测CKD第3阶段和第5阶段的1年ESKD风险,在一个庞大而多样化的群体中.
- 这些模型在预测CKD第4期患者1年ESKD风险时显示出更高的准确性.
- 需要为各种不良结果开发更个性化的,特定阶段的预测方程,以加强临床决策.
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