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Prediction of ESRD and death among people with CKD: the Chronic Renal Impairment in Birmingham (CRIB) prospective cohort study.

Landray MJ, Emberson JR, Blackwell L, Dasgupta T, Zakeri R, Morgan MD, Ferro CJ, Vickery S, Ayrton P, Nair D, Dalton RN, Lamb EJ, Baigent C, Townend JN, Wheeler DC - Am. J. Kidney Dis. (2010)

Bottom Line: For death, age, N-terminal pro-brain natriuretic peptide, troponin T level, and cigarette smoking remained strongly predictive of risk.Other important factors may have been missed because of limited study power.Larger cohort studies are required to further validate these results.

View Article: PubMed Central - PubMed

Affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK. martin.landray@ctsu.ox.ac.uk

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Related in: MedlinePlus

External validation of the CRIB (Chronic Renal Impairment in Birmingham) risk score equations in the East Kent cohort: Kaplan-Meier survival curves by third of the predicted risk distributions (top panels); receiver operating characteristic curves (middle panels); and observed versus predicted annual event rates (bottom panels). The P value for the log-rank test corresponds to the test of equal survival across all 3 predicted risk groups. *Urinary albumin-creatinine ratio was not available in the East Kent cohort; therefore, the measures of discrimination and calibration shown reflect the ability of the other factors (sex, creatinine level, and phosphate level) to predict end-stage renal disease (ESRD) risk. Abbreviations: AUROC, area under the receiver operating characteristic curve (C statistic); CI, confidence interval; NT-pro-BNP, N-terminal pro-brain natriuretic peptide.
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fig3: External validation of the CRIB (Chronic Renal Impairment in Birmingham) risk score equations in the East Kent cohort: Kaplan-Meier survival curves by third of the predicted risk distributions (top panels); receiver operating characteristic curves (middle panels); and observed versus predicted annual event rates (bottom panels). The P value for the log-rank test corresponds to the test of equal survival across all 3 predicted risk groups. *Urinary albumin-creatinine ratio was not available in the East Kent cohort; therefore, the measures of discrimination and calibration shown reflect the ability of the other factors (sex, creatinine level, and phosphate level) to predict end-stage renal disease (ESRD) risk. Abbreviations: AUROC, area under the receiver operating characteristic curve (C statistic); CI, confidence interval; NT-pro-BNP, N-terminal pro-brain natriuretic peptide.

Mentions: Within the East Kent cohort of 213 patients with CKD stages 3-5 (not on renal replacement therapy), baseline characteristics were broadly similar to those in the CRIB Study (see Table S3). Prediction equations derived from the CRIB cohort were assessed independently for discrimination and calibration in the East Kent cohort (because urinary albumin-creatinine ratio was not measured in the East Kent cohort, all participants were assigned an arbitrary value of 350 mg/g). Even without knowledge of ACR, there was clear separation in risk over time between people at low, medium, and high risk of each outcome (Fig 3A), and the AUROC (the C statistic) was very good for both ESRD (0.91; 95% CI, 0.87-0.96) and death (0.82; 95% CI, 0.75-0.89; Fig 3B). When participants in the East Kent cohort were separated into 5 groups based on predicted risks of each outcome, observed annual event rates were systematically lower than predicted rates for ESRD, but reasonably well matched for mortality (Fig 3C). Virtually identical estimates of discrimination and calibration of ESRD risk were obtained when prediction equations that allowed the RR for creatinine level to vary during follow-up were used.


Prediction of ESRD and death among people with CKD: the Chronic Renal Impairment in Birmingham (CRIB) prospective cohort study.

Landray MJ, Emberson JR, Blackwell L, Dasgupta T, Zakeri R, Morgan MD, Ferro CJ, Vickery S, Ayrton P, Nair D, Dalton RN, Lamb EJ, Baigent C, Townend JN, Wheeler DC - Am. J. Kidney Dis. (2010)

External validation of the CRIB (Chronic Renal Impairment in Birmingham) risk score equations in the East Kent cohort: Kaplan-Meier survival curves by third of the predicted risk distributions (top panels); receiver operating characteristic curves (middle panels); and observed versus predicted annual event rates (bottom panels). The P value for the log-rank test corresponds to the test of equal survival across all 3 predicted risk groups. *Urinary albumin-creatinine ratio was not available in the East Kent cohort; therefore, the measures of discrimination and calibration shown reflect the ability of the other factors (sex, creatinine level, and phosphate level) to predict end-stage renal disease (ESRD) risk. Abbreviations: AUROC, area under the receiver operating characteristic curve (C statistic); CI, confidence interval; NT-pro-BNP, N-terminal pro-brain natriuretic peptide.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2991589&req=5

fig3: External validation of the CRIB (Chronic Renal Impairment in Birmingham) risk score equations in the East Kent cohort: Kaplan-Meier survival curves by third of the predicted risk distributions (top panels); receiver operating characteristic curves (middle panels); and observed versus predicted annual event rates (bottom panels). The P value for the log-rank test corresponds to the test of equal survival across all 3 predicted risk groups. *Urinary albumin-creatinine ratio was not available in the East Kent cohort; therefore, the measures of discrimination and calibration shown reflect the ability of the other factors (sex, creatinine level, and phosphate level) to predict end-stage renal disease (ESRD) risk. Abbreviations: AUROC, area under the receiver operating characteristic curve (C statistic); CI, confidence interval; NT-pro-BNP, N-terminal pro-brain natriuretic peptide.
Mentions: Within the East Kent cohort of 213 patients with CKD stages 3-5 (not on renal replacement therapy), baseline characteristics were broadly similar to those in the CRIB Study (see Table S3). Prediction equations derived from the CRIB cohort were assessed independently for discrimination and calibration in the East Kent cohort (because urinary albumin-creatinine ratio was not measured in the East Kent cohort, all participants were assigned an arbitrary value of 350 mg/g). Even without knowledge of ACR, there was clear separation in risk over time between people at low, medium, and high risk of each outcome (Fig 3A), and the AUROC (the C statistic) was very good for both ESRD (0.91; 95% CI, 0.87-0.96) and death (0.82; 95% CI, 0.75-0.89; Fig 3B). When participants in the East Kent cohort were separated into 5 groups based on predicted risks of each outcome, observed annual event rates were systematically lower than predicted rates for ESRD, but reasonably well matched for mortality (Fig 3C). Virtually identical estimates of discrimination and calibration of ESRD risk were obtained when prediction equations that allowed the RR for creatinine level to vary during follow-up were used.

Bottom Line: For death, age, N-terminal pro-brain natriuretic peptide, troponin T level, and cigarette smoking remained strongly predictive of risk.Other important factors may have been missed because of limited study power.Larger cohort studies are required to further validate these results.

View Article: PubMed Central - PubMed

Affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK. martin.landray@ctsu.ox.ac.uk

Show MeSH
Related in: MedlinePlus