scholarly journals Estimating Urine Albumin-to-Creatinine Ratio from Protein-to-Creatinine Ratio: Development of Equations using Same-Day Measurements

2020 ◽  
Vol 31 (3) ◽  
pp. 591-601 ◽  
Author(s):  
Robert G. Weaver ◽  
Matthew T. James ◽  
Pietro Ravani ◽  
Colin G.W. Weaver ◽  
Edmund J. Lamb ◽  
...  
Keyword(s):  
Kidney Failure ◽  
Population Based ◽  
Cubic Splines ◽  
Creatinine Ratio ◽  
Protein Ratio ◽  
Risk Equation ◽  
Urine Albumin ◽  
Failure Risk ◽  
The Relationship ◽  
Linear Splines

BackgroundUrine albumin-to-creatinine ratio (ACR) and protein-to-creatinine ratio (PCR) are used to measure urine protein. Recent guidelines endorse ACR use, and equations have been developed incorporating ACR to predict risk of kidney failure. For situations in which PCR only is available, having a method to estimate ACR from PCR as accurately as possible would be useful.MethodsWe used data from a population-based cohort of 47,714 adults in Alberta, Canada, who had simultaneous assessments of urine ACR and PCR. After log-transforming ACR and PCR, we used cubic splines and quantile regression to estimate the median ACR from a PCR, allowing for modification by specified covariates. On the basis of the cubic splines, we created models using linear splines to develop equations to estimate ACR from PCR. In a subcohort with eGFR<60 ml/min per 1.73 m2, we then used the kidney failure risk equation to compare kidney failure risk using measured ACR as well as estimated ACR that had been derived from PCR.ResultsWe found a nonlinear association between log(ACR) and log(PCR), with the implied albumin-to-protein ratio increasing from <30% in normal to mild proteinuria to about 70% in severe proteinuria, and with wider prediction intervals at lower levels. Sex was the most important modifier of the relationship between ACR and PCR, with men generally having a higher albumin-to-protein ratio. Estimates of kidney failure risk were similar using measured ACR and ACR estimated from PCR.ConclusionsWe developed equations to estimate the median ACR from a PCR, optionally including specified covariates. These equations may prove useful in certain retrospective clinical or research applications where only PCR is available.

scholarly journals Estimating kidney failure risk using electronic medical records

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0005592020
Author(s):  
Felipe S. Naranjo ◽  
Yingying Sang ◽  
Shoshana H. Ballew ◽  
Nikita Stempniewicz ◽  
Stephan C. Dunning ◽  
...  
Keyword(s):  
Electronic Medical Records ◽  
Kidney Failure ◽  
Medical Records ◽  
Individual Risk ◽  
Systematic Bias ◽  
Risk Equation ◽  
Protein Levels ◽  
Urine Dipstick ◽  
Urine Albumin ◽  
Failure Risk

Background: The 4-variable kidney failure risk equation (KFRE) is a well-validated tool for patients with GFR <60 ml/min/1.73 m2 that incorporates age, sex, GFR, and urine albumin-to-creatinine ratio (ACR) to forecast individual risk of kidney failure. Implementing the KFRE in the electronic medical record is challenging, however, due to low ACR testing in clinical practice. The aim of this study was to determine, when ACR is missing, whether to impute ACR from PCR or dipstick protein for use in the 4-variable KFRE or to use the 3-variable KFRE that does not require ACR. Methods: Using electronic health records from OptumLabs® Data Warehouse, patients with eGFR <60 ml/min/1.73 m2 were categorized based on the availability of ACR testing within the previous 3 years. For patients missing ACR, we extracted urine protein-to-creatinine (PCR) and dipstick protein results, comparing the discrimination of the 3-variable KFRE (age, sex, GFR) with the 4-variable KFRE estimated using imputed ACR from PCR and dipstick protein levels. Results: There were 976,299 patients in 39 health care organizations; 59.0% were women, mean age was 72 years and mean eGFR was 47 ml/min/1.73m2. The proportion with ACR testing was 19.3% within the previous 3 years. An additional 1.7% had an available PCR and 36.3% had a dipstick protein; the remaining 42.8% had no form of albuminuria testing. The 4-variable KFRE had significantly better discrimination than the 3-variable KFRE among patients with ACR testing, PCR testing and urine dipstick protein levels, even with imputed ACR for the latter two groups. Calibration of the 4-variable KFRE was acceptable in each group, but the 3-variable equation showed systematic bias in the groups that lacked ACR or PCR testing. Conclusion: Implementation of the KFRE in electronic medical records should incorporate ACR even if only imputed from PCR or urine dipstick protein levels.

scholarly journals A validation study of the 4-variable and 8-variable kidney failure risk equation in transplant recipients in the United Kingdom

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ibrahim Ali ◽  
Philip A. Kalra
Keyword(s):  
United Kingdom ◽  
Kidney Failure ◽  
Graft Failure ◽  
Risk Scores ◽  
Transplant Recipients ◽  
Good Discrimination ◽  
Risk Equation ◽  
The United Kingdom ◽  
Failure Risk ◽  
Risk Patients

Abstract Background There is emerging evidence that the 4-variable Kidney Failure Risk Equation (KFRE) can be used for risk prediction of graft failure in transplant recipients. However, geographical validation of the 4-variable KFRE in transplant patients is lacking, as is whether the more extensive 8-variable KFRE improves predictive accuracy. This study aimed to validate the 4- and 8-variable KFRE predictions of the 5-year death-censored risk of graft failure in patients in the United Kingdom. Methods A retrospective cohort study involved 415 transplant recipients who had their first renal transplant between 2003 and 2015 and were under follow-up at Salford Royal NHS Foundation Trust. The KFRE risk scores were calculated on variables taken 1-year post-transplant. The area under the receiver operating characteristic curves (AUC) and calibration plots were evaluated to determine discrimination and calibration of the 4- and 8-variable KFREs in the whole cohort as well as in a subgroup analysis of living and deceased donor recipients and in patients with an eGFR< 45 ml/min/1.73m2. Results There were 16 graft failure events (4%) in the whole cohort. The 4- and 8-variable KFREs showed good discrimination with AUC of 0.743 (95% confidence interval [CI] 0.610–0.876) and 0.751 (95% CI 0.629–0.872) respectively. In patients with an eGFR< 45 ml/min/1.73m2, the 8-variable KFRE had good discrimination with an AUC of 0.785 (95% CI 0.558–0.982) but the 4-variable provided excellent discrimination in this group with an AUC of 0.817 (0.646–0.988). Calibration plots however showed poor calibration with risk scores tending to underestimate risk of graft failure in low-risk patients and overestimate risk in high-risk patients, which was seen in the primary and subgroup analyses. Conclusions Despite adequate discrimination, the 4- and 8-variable KFREs are imprecise in predicting graft failure in transplant recipients using data 1-year post-transplant. Larger, international studies involving diverse patient populations should be considered to corroborate these findings.

scholarly journals External Validation of the Kidney Failure Risk Equation and Re-Calibration with Addition of Ultrasound Parameters

2016 ◽  
Vol 11 (4) ◽  
pp. 609-615 ◽  
Author(s):  
Claudia S. Lennartz ◽  
John William Pickering ◽  
Sarah Seiler-Mußler ◽  
Lucie Bauer ◽  
Kathrin Untersteller ◽  
...  
Keyword(s):  
Kidney Failure ◽  
External Validation ◽  
Risk Equation ◽  
Failure Risk ◽  
Ultrasound Parameters

scholarly journals The Kidney Failure Risk Equation Score and CKD Care Delivery Measures: A Cross-sectional Study

2021 ◽  
Author(s):  
Salman Ahmed ◽  
Suraj Sarvode Mothi ◽  
Thomas Sequist ◽  
Navdeep Tangri ◽  
Roaa M. Khinkar ◽  
...  
Keyword(s):  
Kidney Failure ◽  
Care Delivery ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Risk Equation ◽  
Failure Risk

scholarly journals Use of the Kidney Failure Risk Equation to Determine the Risk of Progression to End-stage Renal Disease in Children With Chronic Kidney Disease

2018 ◽  
Vol 172 (2) ◽  
pp. 174 ◽  
Author(s):  
Erica Winnicki ◽  
Charles E. McCulloch ◽  
Mark M. Mitsnefes ◽  
Susan L. Furth ◽  
Bradley A. Warady ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
Kidney Failure ◽  
End Stage Renal Disease ◽  
Risk Equation ◽  
Failure Risk ◽  
Risk Of Progression ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Validation of the Kidney Failure Risk Equation in Manitoba

2017 ◽  
Vol 4 ◽  
pp. 205435811770537 ◽  
Author(s):  
Reid H. Whitlock ◽  
Mariette Chartier ◽  
Paul Komenda ◽  
Jay Hingwala ◽  
Claudio Rigatto ◽  
...  
Keyword(s):  
Kidney Failure ◽  
Risk Equation ◽  
Failure Risk

scholarly journals Influence of Mortality on Estimating the Risk of Kidney Failure in People with Stage 4 CKD

2019 ◽  
Vol 30 (11) ◽  
pp. 2219-2227 ◽  
Author(s):  
Pietro Ravani ◽  
Marta Fiocco ◽  
Ping Liu ◽  
Robert R. Quinn ◽  
Brenda Hemmelgarn ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Kidney Failure ◽  
Absolute Risk ◽  
Population Based ◽  
Comparison Standard ◽  
Risk Of Death ◽  
Failure Risk ◽  
Stage 4 ◽  
Standard Risk ◽  
Over Time

BackgroundMost kidney failure risk calculators are based on methods that censor for death. Because mortality is high in people with severe, nondialysis-dependent CKD, censoring for death may overestimate their risk of kidney failure.MethodsUsing 2002–2014 population-based laboratory and administrative data for adults with stage 4 CKD in Alberta, Canada, we analyzed the time to the earliest of kidney failure, death, or censoring, using methods that censor for death and methods that treat death as a competing event factoring in age, sex, diabetes, cardiovascular disease, eGFR, and albuminuria. Stage 4 CKD was defined as a sustained eGFR of 15–30 ml/min per 1.73 m2.ResultsOf the 30,801 participants (106,447 patient-years at risk; mean age 77 years), 18% developed kidney failure and 53% died. The observed risk of the combined end point of death or kidney failure was 64% at 5 years and 87% at 10 years. By comparison, standard risk calculators that censored for death estimated these risks to be 76% at 5 years and >100% at 7.5 years. Censoring for death increasingly overestimated the risk of kidney failure over time from 7% at 5 years to 19% at 10 years, especially in people at higher risk of death. For example, the overestimation of 5-year absolute risk ranged from 1% in a woman without diabetes, cardiovascular disease, or albuminuria and with an eGFR of 25 ml/min per 1.73 m2 (9% versus 8%), to 27% in a man with diabetes, cardiovascular disease, albuminuria >300 mg/d, and an eGFR of 20 ml/min per 1.73 m2 (78% versus 51%).ConclusionsKidney failure risk calculators should account for death as a competing risk to increase their accuracy and utility for patients and providers.

scholarly journals Performance of the Kidney Failure Risk Equation by Disease Etiology in Advanced CKD

2020 ◽  
Vol 15 (10) ◽  
pp. 1424-1432
Author(s):  
Gregory L. Hundemer ◽  
Navdeep Tangri ◽  
Manish M. Sood ◽  
Tim Ramsay ◽  
Ann Bugeja ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Confidence Interval ◽  
Kidney Failure ◽  
Operating Characteristic ◽  
Area Under The Curve ◽  
Polycystic Kidney ◽  
Receiver Operating Characteristic Curves ◽  
Time Points ◽  
Risk Equation ◽  
Failure Risk

Background and objectivesThe kidney failure risk equation is a clinical tool commonly used for prediction of progression from CKD to kidney failure. The kidney failure risk equation’s accuracy in advanced CKD and whether this varies by CKD etiology remains unknown. This study examined the kidney failure risk equation’s discrimination and calibration at 2 and 5 years among a large tertiary care population with advanced CKD from heterogeneous etiologies.Design, setting, participants, & measurementsThis retrospective cohort study included 1293 patients with advanced CKD (median eGFR 15 ml/min per 1.73 m2) referred to the Ottawa Hospital Multi-Care Kidney Clinic between 2010 and 2016, with follow-up clinical data available through 2018. Four-variable kidney failure risk equation scores for 2- and 5-year risks of progression to kidney failure (defined as dialysis or kidney transplantation) were calculated upon initial referral and correlated with the subsequent observed kidney failure incidence within these time frames. Receiver operating characteristic curves and calibration plots were used to measure the discrimination and calibration of the kidney failure risk equation both in the overall advanced CKD population and by CKD etiology: diabetic kidney disease, hypertensive nephrosclerosis, GN, polycystic kidney disease, and other. Pairwise comparisons of the receiver operating characteristic curves by CKD etiology were performed to compare kidney failure risk equation discrimination.ResultsThe kidney failure risk equation provided adequate to excellent discrimination in identifying patients with CKD likely to progress to kidney failure at the 2- and 5-year time points both overall (2-year area under the curve, 0.83; 95% confidence interval, 0.81 to 0.85; 5-year area under the curve, 0.81; 95% confidence interval, 0.77 to 0.84) and across CKD etiologies. The kidney failure risk equation displayed adequate calibration at the 2- and 5-year time points both overall and across CKD etiologies (Hosmer–Lemeshow P≥0.05); however, the predicted risks of kidney failure were higher than the observed risks across CKD etiologies with the exception of polycystic kidney disease.ConclusionsThe kidney failure risk equation provides adequate discrimination and calibration in advanced CKD and across CKD etiologies.

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