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877519.pdf (5.39 MB)

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2025-01-29

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cc-by (c) Bundó-Luque, Daniel et al., 2025
Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/220447

Recalibrating the kidney failure risk equation for a Mediterranean European population: reducing age and sex inequality

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Recurs relacionat

https://doi.org/10.3389/fmed.2024.1497780

Resum

Introduction: Chronic kidney disease (CKD) patients may develop kidney failure (KF), receiving renal replacement therapy (RRT) in some cases. The Kidney Failure Risk Equation (KFRE-4), predicting RRT risk, is widely validated but not in a primary care Mediterranean European population. We aim to recalibrate KFRE-4 accordingly, considering death as a competing risk, to improve performance. Additionally, we recalibrate KFRE-4 for predicting KF, including all patients reaching CKD stage 5, not just those on RRT. Methods: Retrospective cohort study including individuals aged ≥50 years with confirmed glomerular filtration rate (eGFR) <60 mL/min/1.73m2 and measured albumin-to-creatinine ratio (ACR). Dataset was split into training and test sets. New KFRE-4 models were developed in the training set and performance was evaluated in the test set: Base hazard adapted-KFRE (Basic-RRT), Cox reestimation (Cox- RRT), Fine and Gray RRT reestimation (FG-RRT), and Fine and Gray KF reestimation (FG-KF). Results: Among 165,371 primary care patients (58.1% female; mean age 78.1 years; mean eGFR 47.3 mL/min/1.73m2, median ACR 10.1 mg/g), original KFRE-4 showed good discrimination but poor calibration, overestimating RRT risk. Basic-RRT showed poorer performance. Cox-RRT and FG-RRT, enhancing the influence of old age and female sex, diminished overprediction. FG-RRT, considering death as a competing risk, resulted the best RRT model. Age and sex had less impact on KF prediction. Conclusion: A fully tailored recalibration model diminished RRT overprediction. Considering death as a competing event optimizes performance. Recalibrating for KF prediction offers a more inclusive approach in primary care, addressing the needs of women and elderly.

Matèries

Factors sexuals en les malalties, Insuficiència renal crònica, Persones grans

Matèries (anglès)

Sex factors in disease, Chronic renal failure, Older people

Citació

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Articles publicats en revistes (Ciències Clíniques)
Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))

Citació

BUNDÓ, Daniel, et al. Recalibrating the kidney failure risk equation for a Mediterranean European population: reducing age and sex inequality. Frontiers in Medicine. 2025. Vol. 11. ISSN 2296-858X. [consulted: 17 of August of 2026]. Available at: https://hdl.handle.net/2445/220447

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