{"title":"CKD-CAREMEAU队列中根据慢性肾病病因的肾衰竭风险方程表现。","authors":"Julien Prouvot, Pedram Ahmadpoor, Edouard Clemmer, Florian Garo, Emilie Pambrun, Sylvain Cariou, Pascal Reboul, Ziyad Messikh, Olivier Moranne","doi":"10.1093/ckj/sfaf258","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The Kidney Failure Risk Equation (KFRE) is a prognostic score for predicting kidney replacement therapy (KRT) at 5 years in patients with chronic kidney disease (CKD). Some studies show that the score performs poorly for certain etiologies of CKD but not all have been evaluated. The aim of this study was to evaluate the performance of the KFRE score according to the etiology of the CKD.</p><p><strong>Methods: </strong>The CKD-CAREMEAU cohort, which included all patients who consulted a nephrologist for CKD between 2008 and 2017, was used. Patients were monitored for 5 years and the observed event was KRT, completed by the French REIN registry (Reseau Epidemiologique et Information en Néphrologie). Performance was evaluated by calibration (individual approach) and discrimination (populational approach), using observed vs predicted risk curves and the area under curve, respectively, according to each etiology.</p><p><strong>Results: </strong>A total of 3191 patients were included in the study, median age 71 (interquartile range 61-80) years, 1921 (60%) of whom were men, and the median estimated glomerular filtration rate was 41 (28-80) mL/min/1.73 m². The main etiologies of CKD were vascular; 1164 patients (37%), diabetic; 667 (21%), glomerular; 512 (16%), tubulointerstitial; 459 (14%), polycystic; 121 (4%) and unclassified; and 268(8%). Discrimination was satisfactory for all etiologies, but calibration was unsatisfactory for polycystic, tubulointerstitial and unclassified (multiple or unknown) etiologies, without correlation with age.</p><p><strong>Conclusions: </strong>Predictive performance of the KFRE score at 5 years varies according to the etiology of CKD, without impact on discrimination, but with a significant impact on calibration, and poor performance for polycystic, tubulointerstitial and multiple/unknown etiologies. These limitations should be known in order to develop new prognostic tools.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf258"},"PeriodicalIF":4.6000,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415514/pdf/","citationCount":"0","resultStr":"{\"title\":\"Kidney Failure Risk Equation performance according to the etiology of chronic kidney disease in the CKD-CAREMEAU cohort.\",\"authors\":\"Julien Prouvot, Pedram Ahmadpoor, Edouard Clemmer, Florian Garo, Emilie Pambrun, Sylvain Cariou, Pascal Reboul, Ziyad Messikh, Olivier Moranne\",\"doi\":\"10.1093/ckj/sfaf258\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The Kidney Failure Risk Equation (KFRE) is a prognostic score for predicting kidney replacement therapy (KRT) at 5 years in patients with chronic kidney disease (CKD). Some studies show that the score performs poorly for certain etiologies of CKD but not all have been evaluated. The aim of this study was to evaluate the performance of the KFRE score according to the etiology of the CKD.</p><p><strong>Methods: </strong>The CKD-CAREMEAU cohort, which included all patients who consulted a nephrologist for CKD between 2008 and 2017, was used. Patients were monitored for 5 years and the observed event was KRT, completed by the French REIN registry (Reseau Epidemiologique et Information en Néphrologie). Performance was evaluated by calibration (individual approach) and discrimination (populational approach), using observed vs predicted risk curves and the area under curve, respectively, according to each etiology.</p><p><strong>Results: </strong>A total of 3191 patients were included in the study, median age 71 (interquartile range 61-80) years, 1921 (60%) of whom were men, and the median estimated glomerular filtration rate was 41 (28-80) mL/min/1.73 m². The main etiologies of CKD were vascular; 1164 patients (37%), diabetic; 667 (21%), glomerular; 512 (16%), tubulointerstitial; 459 (14%), polycystic; 121 (4%) and unclassified; and 268(8%). Discrimination was satisfactory for all etiologies, but calibration was unsatisfactory for polycystic, tubulointerstitial and unclassified (multiple or unknown) etiologies, without correlation with age.</p><p><strong>Conclusions: </strong>Predictive performance of the KFRE score at 5 years varies according to the etiology of CKD, without impact on discrimination, but with a significant impact on calibration, and poor performance for polycystic, tubulointerstitial and multiple/unknown etiologies. These limitations should be known in order to develop new prognostic tools.</p>\",\"PeriodicalId\":10435,\"journal\":{\"name\":\"Clinical Kidney Journal\",\"volume\":\"18 9\",\"pages\":\"sfaf258\"},\"PeriodicalIF\":4.6000,\"publicationDate\":\"2025-08-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415514/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Kidney Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ckj/sfaf258\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/9/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Kidney Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ckj/sfaf258","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/9/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:肾衰竭风险方程(KFRE)是预测慢性肾脏疾病(CKD)患者5年肾脏替代治疗(KRT)的预后评分。一些研究表明,该评分对CKD的某些病因表现不佳,但并非所有病因都得到了评估。本研究的目的是根据CKD的病因来评估KFRE评分的表现。方法:采用CKD- caremeau队列,包括2008年至2017年期间因CKD咨询肾病专家的所有患者。对患者进行为期5年的监测,观察到的事件是KRT,由法国REIN登记处(Reseau Epidemiologique et Information en n phrology)完成。根据每种病因,分别使用观察到的与预测的风险曲线和曲线下面积,通过校准(个体方法)和判别(群体方法)对效果进行评估。结果:研究共纳入3191例患者,中位年龄71岁(四分位间距61-80),其中1921例(60%)为男性,肾小球滤过率中位估计为41 (28-80)mL/min/1.73 m²。CKD的主要病因是血管;1164例(37%),糖尿病;肾小球667例(21%);512例(16%)为小管间质性;459例(14%)为多囊性;121(4%)和未分类;和268年(8%)。所有病因的鉴别都令人满意,但对多囊性、小管间质性和未分类(多种或未知)病因的校正不令人满意,与年龄无关。结论:5年KFRE评分的预测性能因CKD病因而异,对区分没有影响,但对校准有显著影响,对多囊性、小管间质性和多种/未知病因的预测性能较差。为了开发新的预后工具,应该了解这些局限性。
Kidney Failure Risk Equation performance according to the etiology of chronic kidney disease in the CKD-CAREMEAU cohort.
Background: The Kidney Failure Risk Equation (KFRE) is a prognostic score for predicting kidney replacement therapy (KRT) at 5 years in patients with chronic kidney disease (CKD). Some studies show that the score performs poorly for certain etiologies of CKD but not all have been evaluated. The aim of this study was to evaluate the performance of the KFRE score according to the etiology of the CKD.
Methods: The CKD-CAREMEAU cohort, which included all patients who consulted a nephrologist for CKD between 2008 and 2017, was used. Patients were monitored for 5 years and the observed event was KRT, completed by the French REIN registry (Reseau Epidemiologique et Information en Néphrologie). Performance was evaluated by calibration (individual approach) and discrimination (populational approach), using observed vs predicted risk curves and the area under curve, respectively, according to each etiology.
Results: A total of 3191 patients were included in the study, median age 71 (interquartile range 61-80) years, 1921 (60%) of whom were men, and the median estimated glomerular filtration rate was 41 (28-80) mL/min/1.73 m². The main etiologies of CKD were vascular; 1164 patients (37%), diabetic; 667 (21%), glomerular; 512 (16%), tubulointerstitial; 459 (14%), polycystic; 121 (4%) and unclassified; and 268(8%). Discrimination was satisfactory for all etiologies, but calibration was unsatisfactory for polycystic, tubulointerstitial and unclassified (multiple or unknown) etiologies, without correlation with age.
Conclusions: Predictive performance of the KFRE score at 5 years varies according to the etiology of CKD, without impact on discrimination, but with a significant impact on calibration, and poor performance for polycystic, tubulointerstitial and multiple/unknown etiologies. These limitations should be known in order to develop new prognostic tools.
期刊介绍:
About the Journal
Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.