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Validation of two prediction models of undiagnosed chronic kidney disease in mixed-ancestry South Africans.

Mogueo A, Echouffo-Tcheugui JB, Matsha TE, Erasmus RT, Kengne AP - BMC Nephrol (2015)

Bottom Line: Discrimination was better in men, older and normal weight individuals.Intercept adjustment significantly improved the calibration with an expected/observed risk of 'eGFR <60 ml/min/1.73 m(2)' and 'any nephropathy' respectively of 0.98 (0.87-1.10) and 0.97 (0.86-1.09) for the Thai model; but resulted in an underestimation by 24 % with the Korean model.This highlights the potential importance of using existing models for risk CKD screening in developing countries.

View Article: PubMed Central - PubMed

Affiliation: Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa. amely.mogueo@yahoo.fr.

ABSTRACT

Background: Chronic kidney disease (CKD) is a global challenge. Risk models to predict prevalent undiagnosed CKD have been published. However, none was developed or validated in an African population. We validated the Korean and Thai CKD prediction model in mixed-ancestry South Africans.

Methods: Discrimination and calibration were assessed overall and by major subgroups. CKD was defined as 'estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2)' or 'any nephropathy'. eGFR was based on the 4-variable Modification of Diet in Renal Disease (MDRD) formula.

Results: In all 902 participants (mean age 55 years) included, 259 (28.7 %) had prevalent undiagnosed CKD. C-statistics were 0.76 (95 % CI: 0.73-0.79) for 'eGFR <60 ml/min/1.73 m(2)' and 0.81 (0.78-0.84) for 'any nephropathy' for the Korean model; corresponding values for the Thai model were 0.80 (0.77-0.83) and 0.77 (0.74-0.81). Discrimination was better in men, older and normal weight individuals. The model underestimated CKD risk by 10 % to 13 % for the Thai and 9 % to 93 % for the Korean model. Intercept adjustment significantly improved the calibration with an expected/observed risk of 'eGFR <60 ml/min/1.73 m(2)' and 'any nephropathy' respectively of 0.98 (0.87-1.10) and 0.97 (0.86-1.09) for the Thai model; but resulted in an underestimation by 24 % with the Korean model. Results were broadly similar for CKD derived from the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula.

Conclusion: Asian prevalent CKD risk models had acceptable performances in mixed-ancestry South Africans. This highlights the potential importance of using existing models for risk CKD screening in developing countries.

No MeSH data available.


Related in: MedlinePlus

Receiver operating characteristic curves (ROC) showing the discrimination of the Korean model. The yellow band around curve represents the 95 % confidence interval; the diagonal line at 45° is the line of no discrimination. Figure panels are for the outcome of CKD (eGFR < 60 ml/min/1.73 m2) for the left panels and ‘any nephropathy (eGFR < 60 ml/min/1.73 m2 or proteinuria) for the right panels, and for MDRD defined CKD (upper panels) and CKD-EPI defined CKD (lower panels)
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Fig1: Receiver operating characteristic curves (ROC) showing the discrimination of the Korean model. The yellow band around curve represents the 95 % confidence interval; the diagonal line at 45° is the line of no discrimination. Figure panels are for the outcome of CKD (eGFR < 60 ml/min/1.73 m2) for the left panels and ‘any nephropathy (eGFR < 60 ml/min/1.73 m2 or proteinuria) for the right panels, and for MDRD defined CKD (upper panels) and CKD-EPI defined CKD (lower panels)

Mentions: A total of 259 participants (28.7 %) had undiagnosed CKD (eGFR < 60 ml/min/1.73 m2). When using the eGFR < 60 ml/min/1.73 m2 and/or albuminuria as the definition of CKD, nine additional patients (solely women) would have the condition (Table 1). Table 2 and Figs. 1 and 2 show the discriminative ability of two prediction models selected. The C-statistic was 0.760 (95 % CI: 0.726-0793) for the Korean model for predicting ‘eGFR < 60 ml/min/1.73 m2’ and 0.811 (0.780-0.842) for ‘any nephropathy’; corresponding figures were 0.797 (0.765-0.829) and 0772 (0.739-0.805) for the Thai model. In all pairwise comparisons, the Korean model always had significantly better discrimination than the Thai model (all p < 0.0001).Table 2


Validation of two prediction models of undiagnosed chronic kidney disease in mixed-ancestry South Africans.

Mogueo A, Echouffo-Tcheugui JB, Matsha TE, Erasmus RT, Kengne AP - BMC Nephrol (2015)

Receiver operating characteristic curves (ROC) showing the discrimination of the Korean model. The yellow band around curve represents the 95 % confidence interval; the diagonal line at 45° is the line of no discrimination. Figure panels are for the outcome of CKD (eGFR < 60 ml/min/1.73 m2) for the left panels and ‘any nephropathy (eGFR < 60 ml/min/1.73 m2 or proteinuria) for the right panels, and for MDRD defined CKD (upper panels) and CKD-EPI defined CKD (lower panels)
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4491228&req=5

Fig1: Receiver operating characteristic curves (ROC) showing the discrimination of the Korean model. The yellow band around curve represents the 95 % confidence interval; the diagonal line at 45° is the line of no discrimination. Figure panels are for the outcome of CKD (eGFR < 60 ml/min/1.73 m2) for the left panels and ‘any nephropathy (eGFR < 60 ml/min/1.73 m2 or proteinuria) for the right panels, and for MDRD defined CKD (upper panels) and CKD-EPI defined CKD (lower panels)
Mentions: A total of 259 participants (28.7 %) had undiagnosed CKD (eGFR < 60 ml/min/1.73 m2). When using the eGFR < 60 ml/min/1.73 m2 and/or albuminuria as the definition of CKD, nine additional patients (solely women) would have the condition (Table 1). Table 2 and Figs. 1 and 2 show the discriminative ability of two prediction models selected. The C-statistic was 0.760 (95 % CI: 0.726-0793) for the Korean model for predicting ‘eGFR < 60 ml/min/1.73 m2’ and 0.811 (0.780-0.842) for ‘any nephropathy’; corresponding figures were 0.797 (0.765-0.829) and 0772 (0.739-0.805) for the Thai model. In all pairwise comparisons, the Korean model always had significantly better discrimination than the Thai model (all p < 0.0001).Table 2

Bottom Line: Discrimination was better in men, older and normal weight individuals.Intercept adjustment significantly improved the calibration with an expected/observed risk of 'eGFR <60 ml/min/1.73 m(2)' and 'any nephropathy' respectively of 0.98 (0.87-1.10) and 0.97 (0.86-1.09) for the Thai model; but resulted in an underestimation by 24 % with the Korean model.This highlights the potential importance of using existing models for risk CKD screening in developing countries.

View Article: PubMed Central - PubMed

Affiliation: Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa. amely.mogueo@yahoo.fr.

ABSTRACT

Background: Chronic kidney disease (CKD) is a global challenge. Risk models to predict prevalent undiagnosed CKD have been published. However, none was developed or validated in an African population. We validated the Korean and Thai CKD prediction model in mixed-ancestry South Africans.

Methods: Discrimination and calibration were assessed overall and by major subgroups. CKD was defined as 'estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2)' or 'any nephropathy'. eGFR was based on the 4-variable Modification of Diet in Renal Disease (MDRD) formula.

Results: In all 902 participants (mean age 55 years) included, 259 (28.7 %) had prevalent undiagnosed CKD. C-statistics were 0.76 (95 % CI: 0.73-0.79) for 'eGFR <60 ml/min/1.73 m(2)' and 0.81 (0.78-0.84) for 'any nephropathy' for the Korean model; corresponding values for the Thai model were 0.80 (0.77-0.83) and 0.77 (0.74-0.81). Discrimination was better in men, older and normal weight individuals. The model underestimated CKD risk by 10 % to 13 % for the Thai and 9 % to 93 % for the Korean model. Intercept adjustment significantly improved the calibration with an expected/observed risk of 'eGFR <60 ml/min/1.73 m(2)' and 'any nephropathy' respectively of 0.98 (0.87-1.10) and 0.97 (0.86-1.09) for the Thai model; but resulted in an underestimation by 24 % with the Korean model. Results were broadly similar for CKD derived from the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula.

Conclusion: Asian prevalent CKD risk models had acceptable performances in mixed-ancestry South Africans. This highlights the potential importance of using existing models for risk CKD screening in developing countries.

No MeSH data available.


Related in: MedlinePlus