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Evaluation of a predictive model of end-stage kidney disease in a French-based cohort

  • Nephrology - Original Paper
  • Published:
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Abstract

Background

The risk of ESKD is highly heterogeneous among renal diseases, and risk scores were developed to account for multiple progression factors. Kidney failure risk equation (KFRE) is the most widely accepted, although external validation is scarce. The objective of this study was to evaluate the usefulness of this score in a French case–control cohort and test the pertinence of the proposed thresholds.

Methods

A retrospective case–control study comparing a group of patients starting renal replacement therapy (RRT) to a group of patients with CKD stages 3–5. Multivariate analysis to assess the predictors of ESKD risk. Discrimination of 4-, 6- and 8-variable scores using ROC curves and compared with eGFR alone and albumin/creatinine ratio (ACR) alone.

Results

314 patients with a ratio of 1 case for 1 control. In multivariate analysis, increasing age and higher eGFR were associated with a lower risk of ESKD (OR 0.62, 95% CI 0.48–0.79; and OR 0.72, 95% CI 0.59–0.86, respectively). The log-transformed ACR was associated with a higher risk of ESKD (OR 1.25 per log unit, 95% CI 1.02–1.55). The 4-variable score was significantly higher in the RRT group than in the CKD-ND group, and was more efficient than the eGFR (AUROC 0.66, 95% CI 0.60–0.72, p = 0.018) and the log-transformed ACR (AUROC 0.63 95% CI 0.60–0.72, p = 0.0087) to predict ESKD. The 6-variable score including BP metrics and diabetes was not more discriminant as the 4-variable score. The 8-variable score had similar performance compared with the 4-score (AUROC 8-variable score: 0.70, 95% CI 0.64–0.76, p = 0.526). A 40% and 20% score thresholds were not superior to eGFR < 15 and 20 mL/min/1.73 m2, respectively. A 10% threshold was more specific than an eGFR < 30 mL/min/1.73 m2.

Conclusion

KFRE was highly discriminant between patients progressing to ESKD vs those non-progressing. The 4-variable score may help stratify renal risk and referral in the numerous patients with stage 3 CKD. Conversely, the proposed thresholds for creating vascular access or preemptive transplantation were not superior to eGFR alone.

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Acknowledgements

We are indebted to Pr E. Sauleau (Department of Biostatistics, University of Strasbourg) for helpful statistical expertise and to the Clinical Research Assistants of AURAL for collecting the data.

List of investigators of the CERENNE Research Group (by alphabetical order): Dr. Dorothée Bazin, Dr. Emmanuelle Charlin, Pr. Thierry Hannedouche, Dr. Thierry Krummel (University Hospital of Strasbourg). Dr. Antoine Gartska, Dr. Olivier Imhoff, Dr. Clotilde Muller (Saint Anne Clinics, Strasbourg). Dr. Yves Dimitrov, Dr. Julien Ott (Haguenau Hospital). Dr. François Chantrel (Mulhouse Hospital). Dr. Claire Borni, Dr. Alexandre Klein (Colmar Hospital).

Funding

None.

Author information

Authors and Affiliations

  1. Department of Nephrology, NHC, Hôpitaux Universitaires de Strasbourg, 1, place de l’Hôpital, 67000, Strasbourg, France

    Maxime Ingwiller, Thierry Krummel, Thierry Hannedouche, Dorothée Bazin & Emmanuelle Charlin

  2. Department of Nephrology, Haguenau Hospital, Haguenau, France

    Yves Dimitrov & Julien Ott

  3. Department of Nephrology, Sainte Anne Clinics, Strasbourg, France

    Clotilde Muller, Antoine Gartska, Olivier Imhoff & Clotilde Muller

  4. Department of Nephrology, Mulhouse Hospital, Mulhouse, France

    François Chantrel

  5. Department of Nephrology, Colmar Hospital, Colmar, France

    Alexandre Klein, Claire Borni & Alexandre Klein

  6. Dialysis Center, AURAL Strasbourg, Strasbourg, France

    Maxime Ingwiller, Yves Dimitrov, Julien Ott, François Chantrel & Claire Borni

  7. Medical School, University of Strasbourg, Strasbourg, France

    Thierry Hannedouche

Authors
  1. Maxime Ingwiller
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  4. Clotilde Muller
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  6. François Chantrel
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  7. Alexandre Klein
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  8. Thierry Hannedouche
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Consortia

For the CERENNE Research Group

  • Dorothée Bazin
  • , Emmanuelle Charlin
  • , Thierry Hannedouche
  • , Thierry Krummel
  • , Antoine Gartska
  • , Olivier Imhoff
  • , Clotilde Muller
  • , François Chantrel
  • , Claire Borni
  •  & Alexandre Klein

Corresponding author

Correspondence to Thierry Hannedouche.

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Ingwiller, M., Krummel, T., Dimitrov, Y. et al. Evaluation of a predictive model of end-stage kidney disease in a French-based cohort. Int Urol Nephrol 54, 2335–2342 (2022). https://doi.org/10.1007/s11255-022-03138-z

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  • DOI: https://doi.org/10.1007/s11255-022-03138-z

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