Development and validation of a model to predict 5-year risk of death without ESRD among older adults with CKD

Nisha Bansal, Ronit Katz, Ian H. De Boer, Carmen A. Peralta, Linda F. Fried, David S. Siscovick, Dena E. Rifkin, Calvin H Hirsch, Steven R. Cummings, Tamara B. Harris, Stephen B. Kritchevsky, Mark J. Sarnak, Michael G. Shlipak, Joachim H. Ix

Research output: Contribution to journalArticle

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Abstract

Background and objectives CKD is associated with mortality. Accurate prediction tools for mortality may guide clinical decision-making, particularly among elderly persons with CKD. Design, setting, participants, & measurements A prediction equation was developed for 5-year risk of mortality among participants with CKD in the Cardiovascular Health Study. Sixteen candidate predictor variables were explored, which included demographics, physical examination measures, comorbidity, medication use, and kidney function measures (eGFR calculated from serum creatinine and the CKD Epidemiology Collaboration equation and the urine albumin-to-creatinine ratio).Modelswere developed using Cox regression and evaluated using c statistics. A final parsimonious model was externally validated in an independent cohort of communityliving elders with CKD in the Health, Aging, and Body Composition Study. Results The development cohort included 828 participants who had amean age of 80 (±5.6) years and an eGFR of 47 (±11) ml/min per 1.73 m2, and median albumin-to-creatinine ratio of 13 (interquartile range 6–51) mg/g. The validation cohort included 789 participants who had a mean age of 74 (±2.8) years and an eGFR of 50 (±9) ml/min per 1.73 m2, and median albumin-to-creatinine ratio of 13 (interquartile range 6–42) mg/g. The final model for 5-year mortality risk included age, sex, race, eGFR, urine albumin-to-creatinine ratio, smoking, diabetes mellitus, and history of heart failure and stroke (c statistic=0.72; 95% confidence interval, 0.68 to 0.74).When a pointbasedsystemwas assigned for each ofnine variables in the equation, the estimatedrisk of deathwithin 5 years ranged from 3.8% among participants with the lowest scores to 83.6% among participants with nine points. The model performed fair in external validation (c statistic=0.69; 95% confidence interval, 0.64 to 0.74). Conclusions A simple prediction tool using nine readily available clinical variables can assist in predicting 5-year mortality risk in elderly patients with CKD, which may be useful in counseling patients and guiding clinical decision making.

Original languageEnglish (US)
Pages (from-to)363-371
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume10
Issue number3
DOIs
StatePublished - 2015

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Chronic Kidney Failure
Creatinine
Albumins
Mortality
Urine
Confidence Intervals
Health
Body Composition
Physical Examination
Comorbidity
Counseling
Diabetes Mellitus
Epidemiology
Heart Failure
Smoking
Stroke
Demography
Kidney
Serum
Clinical Decision-Making

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

Development and validation of a model to predict 5-year risk of death without ESRD among older adults with CKD. / Bansal, Nisha; Katz, Ronit; De Boer, Ian H.; Peralta, Carmen A.; Fried, Linda F.; Siscovick, David S.; Rifkin, Dena E.; Hirsch, Calvin H; Cummings, Steven R.; Harris, Tamara B.; Kritchevsky, Stephen B.; Sarnak, Mark J.; Shlipak, Michael G.; Ix, Joachim H.

In: Clinical Journal of the American Society of Nephrology, Vol. 10, No. 3, 2015, p. 363-371.

Research output: Contribution to journalArticle

Bansal, N, Katz, R, De Boer, IH, Peralta, CA, Fried, LF, Siscovick, DS, Rifkin, DE, Hirsch, CH, Cummings, SR, Harris, TB, Kritchevsky, SB, Sarnak, MJ, Shlipak, MG & Ix, JH 2015, 'Development and validation of a model to predict 5-year risk of death without ESRD among older adults with CKD', Clinical Journal of the American Society of Nephrology, vol. 10, no. 3, pp. 363-371. https://doi.org/10.2215/CJN.04650514
Bansal, Nisha ; Katz, Ronit ; De Boer, Ian H. ; Peralta, Carmen A. ; Fried, Linda F. ; Siscovick, David S. ; Rifkin, Dena E. ; Hirsch, Calvin H ; Cummings, Steven R. ; Harris, Tamara B. ; Kritchevsky, Stephen B. ; Sarnak, Mark J. ; Shlipak, Michael G. ; Ix, Joachim H. / Development and validation of a model to predict 5-year risk of death without ESRD among older adults with CKD. In: Clinical Journal of the American Society of Nephrology. 2015 ; Vol. 10, No. 3. pp. 363-371.
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abstract = "Background and objectives CKD is associated with mortality. Accurate prediction tools for mortality may guide clinical decision-making, particularly among elderly persons with CKD. Design, setting, participants, & measurements A prediction equation was developed for 5-year risk of mortality among participants with CKD in the Cardiovascular Health Study. Sixteen candidate predictor variables were explored, which included demographics, physical examination measures, comorbidity, medication use, and kidney function measures (eGFR calculated from serum creatinine and the CKD Epidemiology Collaboration equation and the urine albumin-to-creatinine ratio).Modelswere developed using Cox regression and evaluated using c statistics. A final parsimonious model was externally validated in an independent cohort of communityliving elders with CKD in the Health, Aging, and Body Composition Study. Results The development cohort included 828 participants who had amean age of 80 (±5.6) years and an eGFR of 47 (±11) ml/min per 1.73 m2, and median albumin-to-creatinine ratio of 13 (interquartile range 6–51) mg/g. The validation cohort included 789 participants who had a mean age of 74 (±2.8) years and an eGFR of 50 (±9) ml/min per 1.73 m2, and median albumin-to-creatinine ratio of 13 (interquartile range 6–42) mg/g. The final model for 5-year mortality risk included age, sex, race, eGFR, urine albumin-to-creatinine ratio, smoking, diabetes mellitus, and history of heart failure and stroke (c statistic=0.72; 95{\%} confidence interval, 0.68 to 0.74).When a pointbasedsystemwas assigned for each ofnine variables in the equation, the estimatedrisk of deathwithin 5 years ranged from 3.8{\%} among participants with the lowest scores to 83.6{\%} among participants with nine points. The model performed fair in external validation (c statistic=0.69; 95{\%} confidence interval, 0.64 to 0.74). Conclusions A simple prediction tool using nine readily available clinical variables can assist in predicting 5-year mortality risk in elderly patients with CKD, which may be useful in counseling patients and guiding clinical decision making.",
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T1 - Development and validation of a model to predict 5-year risk of death without ESRD among older adults with CKD

AU - Bansal, Nisha

AU - Katz, Ronit

AU - De Boer, Ian H.

AU - Peralta, Carmen A.

AU - Fried, Linda F.

AU - Siscovick, David S.

AU - Rifkin, Dena E.

AU - Hirsch, Calvin H

AU - Cummings, Steven R.

AU - Harris, Tamara B.

AU - Kritchevsky, Stephen B.

AU - Sarnak, Mark J.

AU - Shlipak, Michael G.

AU - Ix, Joachim H.

PY - 2015

Y1 - 2015

N2 - Background and objectives CKD is associated with mortality. Accurate prediction tools for mortality may guide clinical decision-making, particularly among elderly persons with CKD. Design, setting, participants, & measurements A prediction equation was developed for 5-year risk of mortality among participants with CKD in the Cardiovascular Health Study. Sixteen candidate predictor variables were explored, which included demographics, physical examination measures, comorbidity, medication use, and kidney function measures (eGFR calculated from serum creatinine and the CKD Epidemiology Collaboration equation and the urine albumin-to-creatinine ratio).Modelswere developed using Cox regression and evaluated using c statistics. A final parsimonious model was externally validated in an independent cohort of communityliving elders with CKD in the Health, Aging, and Body Composition Study. Results The development cohort included 828 participants who had amean age of 80 (±5.6) years and an eGFR of 47 (±11) ml/min per 1.73 m2, and median albumin-to-creatinine ratio of 13 (interquartile range 6–51) mg/g. The validation cohort included 789 participants who had a mean age of 74 (±2.8) years and an eGFR of 50 (±9) ml/min per 1.73 m2, and median albumin-to-creatinine ratio of 13 (interquartile range 6–42) mg/g. The final model for 5-year mortality risk included age, sex, race, eGFR, urine albumin-to-creatinine ratio, smoking, diabetes mellitus, and history of heart failure and stroke (c statistic=0.72; 95% confidence interval, 0.68 to 0.74).When a pointbasedsystemwas assigned for each ofnine variables in the equation, the estimatedrisk of deathwithin 5 years ranged from 3.8% among participants with the lowest scores to 83.6% among participants with nine points. The model performed fair in external validation (c statistic=0.69; 95% confidence interval, 0.64 to 0.74). Conclusions A simple prediction tool using nine readily available clinical variables can assist in predicting 5-year mortality risk in elderly patients with CKD, which may be useful in counseling patients and guiding clinical decision making.

AB - Background and objectives CKD is associated with mortality. Accurate prediction tools for mortality may guide clinical decision-making, particularly among elderly persons with CKD. Design, setting, participants, & measurements A prediction equation was developed for 5-year risk of mortality among participants with CKD in the Cardiovascular Health Study. Sixteen candidate predictor variables were explored, which included demographics, physical examination measures, comorbidity, medication use, and kidney function measures (eGFR calculated from serum creatinine and the CKD Epidemiology Collaboration equation and the urine albumin-to-creatinine ratio).Modelswere developed using Cox regression and evaluated using c statistics. A final parsimonious model was externally validated in an independent cohort of communityliving elders with CKD in the Health, Aging, and Body Composition Study. Results The development cohort included 828 participants who had amean age of 80 (±5.6) years and an eGFR of 47 (±11) ml/min per 1.73 m2, and median albumin-to-creatinine ratio of 13 (interquartile range 6–51) mg/g. The validation cohort included 789 participants who had a mean age of 74 (±2.8) years and an eGFR of 50 (±9) ml/min per 1.73 m2, and median albumin-to-creatinine ratio of 13 (interquartile range 6–42) mg/g. The final model for 5-year mortality risk included age, sex, race, eGFR, urine albumin-to-creatinine ratio, smoking, diabetes mellitus, and history of heart failure and stroke (c statistic=0.72; 95% confidence interval, 0.68 to 0.74).When a pointbasedsystemwas assigned for each ofnine variables in the equation, the estimatedrisk of deathwithin 5 years ranged from 3.8% among participants with the lowest scores to 83.6% among participants with nine points. The model performed fair in external validation (c statistic=0.69; 95% confidence interval, 0.64 to 0.74). Conclusions A simple prediction tool using nine readily available clinical variables can assist in predicting 5-year mortality risk in elderly patients with CKD, which may be useful in counseling patients and guiding clinical decision making.

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