Recalibrating the kidney failure risk equation for a Mediterranean European population: reducing age and sex inequality
IntroductionChronic kidney disease (CKD) patients may develop kidney failure (KF), receiving renal replacement therapy (RRT) in some cases. The Kidney Failure Risk Equation (KFRE-4), predicting RRT risk, is widely validated but not in a primary care Mediterranean European population. We aim to recal...
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Frontiers Media S.A.
2025-01-01
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| author | Daniel Bundó-Luque Daniel Bundó-Luque Daniel Bundó-Luque Oriol Cunillera-Puértolas Oriol Cunillera-Puértolas Sílvia Cobo-Guerrero Sílvia Cobo-Guerrero José Romano José Romano Ariadna Arbiol-Roca Ariadna Arbiol-Roca José Alberto Domínguez-Alonso José Alberto Domínguez-Alonso Josep Maria Cruzado Josep Maria Cruzado Josep Maria Cruzado Betlem Salvador-González Betlem Salvador-González |
| author_facet | Daniel Bundó-Luque Daniel Bundó-Luque Daniel Bundó-Luque Oriol Cunillera-Puértolas Oriol Cunillera-Puértolas Sílvia Cobo-Guerrero Sílvia Cobo-Guerrero José Romano José Romano Ariadna Arbiol-Roca Ariadna Arbiol-Roca José Alberto Domínguez-Alonso José Alberto Domínguez-Alonso Josep Maria Cruzado Josep Maria Cruzado Josep Maria Cruzado Betlem Salvador-González Betlem Salvador-González |
| author_sort | Daniel Bundó-Luque |
| collection | DOAJ |
| description | IntroductionChronic kidney disease (CKD) patients may develop kidney failure (KF), receiving renal replacement therapy (RRT) in some cases. The Kidney Failure Risk Equation (KFRE-4), predicting RRT risk, is widely validated but not in a primary care Mediterranean European population. We aim to recalibrate KFRE-4 accordingly, considering death as a competing risk, to improve performance. Additionally, we recalibrate KFRE-4 for predicting KF, including all patients reaching CKD stage 5, not just those on RRT.MethodsRetrospective cohort study including individuals aged ≥50 years with confirmed glomerular filtration rate (eGFR) <60 mL/min/1.73m2 and measured albumin-to-creatinine ratio (ACR). Dataset was split into training and test sets. New KFRE-4 models were developed in the training set and performance was evaluated in the test set: Base hazard adapted-KFRE (Basic-RRT), Cox reestimation (Cox- RRT), Fine and Gray RRT reestimation (FG-RRT), and Fine and Gray KF reestimation (FG-KF).ResultsAmong 165,371 primary care patients (58.1% female; mean age 78.1 years; mean eGFR 47.3 mL/min/1.73m2, median ACR 10.1 mg/g), original KFRE-4 showed good discrimination but poor calibration, overestimating RRT risk. Basic-RRT showed poorer performance. Cox-RRT and FG-RRT, enhancing the influence of old age and female sex, diminished overprediction. FG-RRT, considering death as a competing risk, resulted the best RRT model. Age and sex had less impact on KF prediction.ConclusionA fully tailored recalibration model diminished RRT overprediction. Considering death as a competing event optimizes performance. Recalibrating for KF prediction offers a more inclusive approach in primary care, addressing the needs of women and elderly. |
| format | Article |
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| institution | Kabale University |
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| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-21d2a6b309424bb694aea77b2296de2a2025-08-20T03:42:14ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-01-011110.3389/fmed.2024.14977801497780Recalibrating the kidney failure risk equation for a Mediterranean European population: reducing age and sex inequalityDaniel Bundó-Luque0Daniel Bundó-Luque1Daniel Bundó-Luque2Oriol Cunillera-Puértolas3Oriol Cunillera-Puértolas4Sílvia Cobo-Guerrero5Sílvia Cobo-Guerrero6José Romano7José Romano8Ariadna Arbiol-Roca9Ariadna Arbiol-Roca10José Alberto Domínguez-Alonso11José Alberto Domínguez-Alonso12Josep Maria Cruzado13Josep Maria Cruzado14Josep Maria Cruzado15Betlem Salvador-González16Betlem Salvador-González17CAP Alt Penedès, Gerència d’Atenció Primària i a la Comunitat del Penedès, Institut Català de la Salut, Vilafranca del Penedès, Barcelona, SpainDisease, Cardiovascular Risk, and Lifestyle in Primary Health Care (MARCEVAP) Research Group, Fundació Institut Universitari per a la recerca a l’Atenció Primària (IDIAPJGol), L’Hospitalet Llobregat, Barcelona, SpainFacultat de Medicina, Universitat de Barcelona (UB), Barcelona, SpainDisease, Cardiovascular Risk, and Lifestyle in Primary Health Care (MARCEVAP) Research Group, Fundació Institut Universitari per a la recerca a l’Atenció Primària (IDIAPJGol), L’Hospitalet Llobregat, Barcelona, SpainUnitat de Suport a la Recerca Metropolitana Sud, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), l’Hospitalet de Llobregat, Barcelona, SpainDisease, Cardiovascular Risk, and Lifestyle in Primary Health Care (MARCEVAP) Research Group, Fundació Institut Universitari per a la recerca a l’Atenció Primària (IDIAPJGol), L’Hospitalet Llobregat, Barcelona, SpainEAP Gavarra, Gerència d’Atenció Primària i a la Comunitat Llobregat, Institut Català de la Salut, Cornellà de Llobregat, Barcelona, SpainDisease, Cardiovascular Risk, and Lifestyle in Primary Health Care (MARCEVAP) Research Group, Fundació Institut Universitari per a la recerca a l’Atenció Primària (IDIAPJGol), L’Hospitalet Llobregat, Barcelona, SpainEAP Sant Josep, Gerència d’Atenció Primària i a la Comunitat Delta Llobregat, Institut Català de la Salut, l’Hospitalet de Llobregat, Barcelona, SpainDisease, Cardiovascular Risk, and Lifestyle in Primary Health Care (MARCEVAP) Research Group, Fundació Institut Universitari per a la recerca a l’Atenció Primària (IDIAPJGol), L’Hospitalet Llobregat, Barcelona, SpainLaboratori Clínic Territorial Metropolitana Sud, Hospital Universitari de Bellvitge, Institut Català de la Salut, l’Hospitalet de Llobregat, Barcelona, SpainDisease, Cardiovascular Risk, and Lifestyle in Primary Health Care (MARCEVAP) Research Group, Fundació Institut Universitari per a la recerca a l’Atenció Primària (IDIAPJGol), L’Hospitalet Llobregat, Barcelona, SpainCAP Vilafranca Nord, Gerència d’Atenció Primària i a la Comunitat del Penedès, Institut Català de la Salut, Vilafranca del Penedès, Barcelona, SpainFacultat de Medicina, Universitat de Barcelona (UB), Barcelona, SpainDepartment of Nephrology, Hospital Universitari Bellvitge, l’Hospitalet de Llobregat, Barcelona, Spain0Nephrology and Renal Transplantation Group, Bellvitge Institute for Biomedical Research (IDIBELL), l’Hospitalet de Llobregat, Barcelona, SpainDisease, Cardiovascular Risk, and Lifestyle in Primary Health Care (MARCEVAP) Research Group, Fundació Institut Universitari per a la recerca a l’Atenció Primària (IDIAPJGol), L’Hospitalet Llobregat, Barcelona, SpainUnitat de Suport a la Recerca Metropolitana Sud, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), l’Hospitalet de Llobregat, Barcelona, SpainIntroductionChronic kidney disease (CKD) patients may develop kidney failure (KF), receiving renal replacement therapy (RRT) in some cases. The Kidney Failure Risk Equation (KFRE-4), predicting RRT risk, is widely validated but not in a primary care Mediterranean European population. We aim to recalibrate KFRE-4 accordingly, considering death as a competing risk, to improve performance. Additionally, we recalibrate KFRE-4 for predicting KF, including all patients reaching CKD stage 5, not just those on RRT.MethodsRetrospective cohort study including individuals aged ≥50 years with confirmed glomerular filtration rate (eGFR) <60 mL/min/1.73m2 and measured albumin-to-creatinine ratio (ACR). Dataset was split into training and test sets. New KFRE-4 models were developed in the training set and performance was evaluated in the test set: Base hazard adapted-KFRE (Basic-RRT), Cox reestimation (Cox- RRT), Fine and Gray RRT reestimation (FG-RRT), and Fine and Gray KF reestimation (FG-KF).ResultsAmong 165,371 primary care patients (58.1% female; mean age 78.1 years; mean eGFR 47.3 mL/min/1.73m2, median ACR 10.1 mg/g), original KFRE-4 showed good discrimination but poor calibration, overestimating RRT risk. Basic-RRT showed poorer performance. Cox-RRT and FG-RRT, enhancing the influence of old age and female sex, diminished overprediction. FG-RRT, considering death as a competing risk, resulted the best RRT model. Age and sex had less impact on KF prediction.ConclusionA fully tailored recalibration model diminished RRT overprediction. Considering death as a competing event optimizes performance. Recalibrating for KF prediction offers a more inclusive approach in primary care, addressing the needs of women and elderly.https://www.frontiersin.org/articles/10.3389/fmed.2024.1497780/fullkidney failureKFRErisk assesementagesexcompeting risk |
| spellingShingle | Daniel Bundó-Luque Daniel Bundó-Luque Daniel Bundó-Luque Oriol Cunillera-Puértolas Oriol Cunillera-Puértolas Sílvia Cobo-Guerrero Sílvia Cobo-Guerrero José Romano José Romano Ariadna Arbiol-Roca Ariadna Arbiol-Roca José Alberto Domínguez-Alonso José Alberto Domínguez-Alonso Josep Maria Cruzado Josep Maria Cruzado Josep Maria Cruzado Betlem Salvador-González Betlem Salvador-González Recalibrating the kidney failure risk equation for a Mediterranean European population: reducing age and sex inequality Frontiers in Medicine kidney failure KFRE risk assesement age sex competing risk |
| title | Recalibrating the kidney failure risk equation for a Mediterranean European population: reducing age and sex inequality |
| title_full | Recalibrating the kidney failure risk equation for a Mediterranean European population: reducing age and sex inequality |
| title_fullStr | Recalibrating the kidney failure risk equation for a Mediterranean European population: reducing age and sex inequality |
| title_full_unstemmed | Recalibrating the kidney failure risk equation for a Mediterranean European population: reducing age and sex inequality |
| title_short | Recalibrating the kidney failure risk equation for a Mediterranean European population: reducing age and sex inequality |
| title_sort | recalibrating the kidney failure risk equation for a mediterranean european population reducing age and sex inequality |
| topic | kidney failure KFRE risk assesement age sex competing risk |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2024.1497780/full |
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