For Publishers
DiscoveryMetadataPeer reviewHostingPublishing
For Researchers
JoinPublishReviewCollect
Register
Blog
About
Search
Advanced search
My ScienceOpen
Search
For Publishers
For Researchers
Blog
About
63
views
35
references
 Top references
cited by
47
    
0 reviews
 Review
0
comments
 Comment
0
recommends
+1 Recommend
0 collections
    0
    shares
      92
      similar
       All similar
      • Record: found
      • Abstract: found
      • Article: not found

      Prediction of ESRD and Death Among People With CKD: The Chronic Renal Impairment in Birmingham (CRIB) Prospective Cohort Study

      research-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Validated prediction scores are required to assess the risks of end-stage renal disease (ESRD) and death in individuals with chronic kidney disease (CKD).

          Study Design

          Prospective cohort study with validation in a separate cohort.

          Setting & Participants

          Cox regression was used to assess the relevance of baseline characteristics to risk of ESRD (mean follow-up, 4.1 years) and death (mean follow-up, 6.0 years) in 382 patients with stages 3-5 CKD not initially on dialysis therapy in the Chronic Renal Impairment in Birmingham (CRIB) Study. Resultant risk prediction equations were tested in a separate cohort of 213 patients with CKD (the East Kent cohort).

          Factors

          44 baseline characteristics (including 30 blood and urine assays).

          Outcomes

          ESRD and all-cause mortality.

          Results

          In the CRIB cohort, 190 patients reached ESRD (12.1%/y) and 150 died (6.5%/y). Each 30% lower baseline estimated glomerular filtration rate was associated with a 3-fold higher ESRD rate and a 1.3-fold higher death rate. After adjustment for each other, only baseline creatinine level, serum phosphate level, urinary albumin-creatinine ratio, and female sex remained strongly ( P < 0.01) predictive of ESRD. For death, age, N-terminal pro-brain natriuretic peptide, troponin T level, and cigarette smoking remained strongly predictive of risk. Using these factors to predict outcomes in the East Kent cohort yielded an area under the receiver operating characteristic curve (ie, C statistic) of 0.91 (95% CI, 0.87-0.96) for ESRD and 0.82 (95% CI, 0.75-0.89) for death.

          Limitations

          Other important factors may have been missed because of limited study power.

          Conclusions

          Simple laboratory measures of kidney and cardiac function plus age, sex, and smoking history can be used to help identify patients with CKD at highest risk of ESRD and death. Larger cohort studies are required to further validate these results.

          Related collections

          Most cited references35

          • Record: found
          • Abstract: found
          • Article: not found

          The meaning and use of the area under a receiver operating characteristic (ROC) curve.

          J A Hanley, B J McNeil, Marnix van Holsbeeck (1982)
          A representation and interpretation of the area under a receiver operating characteristic (ROC) curve obtained by the "rating" method, or by mathematical predictions based on patient characteristics, is presented. It is shown that in such a setting the area represents the probability that a randomly chosen diseased subject is (correctly) rated or ranked with greater suspicion than a randomly chosen non-diseased subject. Moreover, this probability of a correct ranking is the same quantity that is estimated by the already well-studied nonparametric Wilcoxon statistic. These two relationships are exploited to (a) provide rapid closed-form expressions for the approximate magnitude of the sampling variability, i.e., standard error that one uses to accompany the area under a smoothed ROC curve, (b) guide in determining the size of the sample required to provide a sufficiently reliable estimate of this area, and (c) determine how large sample sizes should be to ensure that one can statistically detect differences in the accuracy of diagnostic techniques.
          Article 0 comments Cited 3864 times – based on 0 reviews     Review now
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Chronic kidney disease and mortality risk: a systematic review.

            Marcello Tonelli, Natasha Wiebe, Bruce Culleton … (2006)
            Current guidelines identify people with chronic kidney disease (CKD) as being at high risk for cardiovascular and all-cause mortality. Because as many as 19 million Americans may have CKD, a comprehensive summary of this risk would be potentially useful for planning public health policy. A systematic review of the association between non-dialysis-dependent CKD and the risk for all-cause and cardiovascular mortality was conducted. Patient- and study-related characteristics that influenced the magnitude of these associations also were investigated. MEDLINE and EMBASE databases were searched, and reference lists through December 2004 were consulted. Authors of 10 primary studies provided additional data. Cohort studies or cohort analyses of randomized, controlled trials that compared mortality between those with and without chronically reduced kidney function were included. Studies were excluded from review when participants were followed for < 1 yr or had ESRD. Two reviewers independently extracted data on study setting, quality, participant and renal function characteristics, and outcomes. Thirty-nine studies that followed a total of 1,371,990 participants were reviewed. The unadjusted relative risk for mortality in participants with reduced kidney function compared with those without ranged from 0.94 to 5.0 and was significantly more than 1.0 in 93% of cohorts. Among the 16 studies that provided suitable data, the absolute risk for death increased exponentially with decreasing renal function. Fourteen cohorts described the risk for mortality from reduced kidney function, after adjustment for other established risk factors. Although adjusted relative hazards were consistently lower than unadjusted relative risks (median reduction 17%), they remained significantly more than 1.0 in 71% of cohorts. This review supports current guidelines that identify individuals with CKD as being at high risk for cardiovascular mortality. Determining which interventions best offset this risk remains a health priority.
            Article 0 comments Cited 507 times – based on 0 reviews     Review now
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the United States Medicare population, 1998 to 1999.

              Robert N Foley, Anne M Murray, Shuling Li … (2005)
              Knowledge of the excess risk posed by specific cardiovascular syndromes could help in the development of strategies to reduce premature mortality among patients with chronic kidney disease (CKD). The rates of atherosclerotic vascular disease, congestive heart failure, renal replacement therapy, and death were compared in a 5% sample of the United States Medicare population in 1998 and 1999 (n = 1,091,201). Patients were divided into the following groups: 1, no diabetes, no CKD (79.7%); 2, diabetes, no CKD (16.5%); 3, CKD, no diabetes (2.2%); and 4, both CKD and diabetes (1.6%). During the 2 yr of follow-up, the rates (per 100 patient-years) in the four groups were as follows: atherosclerotic vascular disease, 14.1, 25.3, 35.7, and 49.1; congestive heart failure, 8.6, 18.5, 30.7, and 52.3; renal replacement therapy, 0.04, 0.2, 1.6, and 3.4; and death, 5.5, 8.1, 17.7, and 19.9, respectively (P < 0.0001). With use of Cox regression, the corresponding adjusted hazards ratios were as follows: atherosclerotic vascular disease, 1, 1.30, 1.16, and 1.41 (P < 0.0001); congestive heart failure, 1, 1.44, 1.28, and 1.79 (P < 0.0001); renal replacement therapy, 1, 2.52, 23.1, and 38.9 (P < 0.0001); and death, 1, 1.21, 1.38, and 1.56 (P < 0.0001). On a relative basis, patients with CKD were at a much greater risk for the least frequent study outcome, renal replacement therapy. On an absolute basis, however, the high death rates of patients with CKD may reflect accelerated rates of atherosclerotic vascular disease and congestive heart failure.
              Article 0 comments Cited 236 times – based on 0 reviews     Review now
                Bookmark
                All references

                Author and article information

                Journal
                Journal ID (nlm-ta): Am J Kidney Dis
                Journal ID (iso-abbrev): Am. J. Kidney Dis
                Title: American Journal of Kidney Diseases
                Publisher: W.B. Saunders
                ISSN (Print): 0272-6386
                ISSN (Electronic): 1523-6838
                Publication date PMC-release: December 2010
                Publication date (Print): December 2010
                Volume: 56
                Issue: 6-2
                Pages: 1082-1094
                Affiliations
                [1 ]Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
                [2 ]Queen Elizabeth Hospital, University Hospitals (Birmingham) NHS Foundation Trust, Edgbaston, Birmingham, UK
                [3 ]School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
                [4 ]Department of Clinical Biochemistry, East Kent Hospitals University NHS Trust, Kent and Canterbury Hospital, Canterbury, UK
                [5 ]Department of Chemical Pathology, Barnet and Chase Farm Hospitals NHS Trust, Barnet General Hospital, Barnet, UK
                [6 ]Department of Biochemistry, Royal Free Hospital, London, UK
                [7 ]WellChild Laboratory, King's College London, Evelina Children's Hospital, London, UK
                [8 ]Centre for Nephrology, University College London Medical School, Royal Free Campus, London, UK
                Author notes
                [* ]Address correspondence to Martin J. Landray, PhD, FRCP, Clinical Trial Service Unit and Epidemiological Studies Unit, Richard Doll Bldg, University of Oxford, Old Road Campus, Roosevelt Dr, Oxford, OX3 7LF, United Kingdom martin.landray@ 123456ctsu.ox.ac.uk
                Article
                Publisher ID: YAJKD53508
                DOI: 10.1053/j.ajkd.2010.07.016
                PMC ID: 2991589
                PubMed ID: 21035932
                SO-VID: 7e707fe8-e82a-44f0-84fc-32248999d89d
                Copyright © © 2010 Elsevier Inc.
                License:

                This document may be redistributed and reused, subject to certain conditions.

                History
                Date received : 14 December 2009
                Date accepted : 15 July 2010
                Categories
                Subject: Original Investigation
                Subject: Pathogenesis and Treatment of Kidney Disease

                ScienceOpen disciplines: Nephrology
                Keywords: death,end-stage renal disease,risk prediction,chronic kidney disease,outcomes
                Data availability:
                ScienceOpen disciplines: Nephrology
                Keywords: death, end-stage renal disease, risk prediction, chronic kidney disease, outcomes

                Comments

                Comment on this article

                scite_

                Similar content92

                See all similar

                Cited by45

                See all cited by

                Most referenced authors1,062

                See all reference authors