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Tran DNT, Ducher M, Fouque D, Fauvel JP. External validation of a 2-year all-cause mortality prediction tool developed using machine learning in patients with stage 4-5 chronic kidney disease. J Nephrol 2024:10.1007/s40620-024-02011-9. [PMID: 38965199 DOI: 10.1007/s40620-024-02011-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 06/13/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with increased mortality. Individual mortality prediction could be of interest to improve individual clinical outcomes. Using an independent regional dataset, the aim of the present study was to externally validate the recently published 2-year all-cause mortality prediction tool developed using machine learning. METHODS A validation dataset of stage 4 or 5 CKD outpatients was used. External validation performance of the prediction tool at the optimal cutoff-point was assessed by the area under the receiver operating characteristic curve (AUC-ROC), accuracy, sensitivity, and specificity. A survival analysis was then performed using the Kaplan-Meier method. RESULTS Data of 527 outpatients with stage 4 or 5 CKD were analyzed. During the 2 years of follow-up, 91 patients died and 436 survived. Compared to the learning dataset, patients in the validation dataset were significantly younger, and the ratio of deceased patients in the validation dataset was significantly lower. The performance of the prediction tool at the optimal cutoff-point was: AUC-ROC = 0.72, accuracy = 63.6%, sensitivity = 72.5%, and specificity = 61.7%. The survival curves of the predicted survived and the predicted deceased groups were significantly different (p < 0.001). CONCLUSION The 2-year all-cause mortality prediction tool for patients with stage 4 or 5 CKD showed satisfactory discriminatory capacity with emphasis on sensitivity. The proposed prediction tool appears to be of clinical interest for further development.
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Affiliation(s)
- Dung N T Tran
- Laboratoire de Biométrie et Biologie Évolutive, UMR 5558, CNRS Lyon, Université Claude Bernard Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Lyon, Villeurbanne, France
- Service de Néphrologie, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69003, Lyon, France
| | - Michel Ducher
- Laboratoire de Biométrie et Biologie Évolutive, UMR 5558, CNRS Lyon, Université Claude Bernard Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Lyon, Villeurbanne, France
- EMR3738 Ciblage Thérapeutique en Oncologie, Université Claude Bernard Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Lyon, Villeurbanne, France
| | - Denis Fouque
- Dept Nephrology, Nutrition and Dialysis, Faculté de Médecine Lyon-Sud BP 12165 Chemin du Grand Revoyet, Université Claude Bernard Lyon 1, Carmen, 69921, Lyon, Oulllins, France
- Hôpital Lyon Sud, Hospices Civils de Lyon, 69495, Lyon, Pierre-Benite, France
| | - Jean-Pierre Fauvel
- Laboratoire de Biométrie et Biologie Évolutive, UMR 5558, CNRS Lyon, Université Claude Bernard Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Lyon, Villeurbanne, France.
- Service de Néphrologie, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69003, Lyon, France.
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Xie D, Ma T, Cui H, Li J, Zhang A, Sheng Z, Xie Y. Global burden and influencing factors of chronic kidney disease due to type 2 diabetes in adults aged 20-59 years, 1990-2019. Sci Rep 2023; 13:20234. [PMID: 37981642 PMCID: PMC10658077 DOI: 10.1038/s41598-023-47091-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/09/2023] [Indexed: 11/21/2023] Open
Abstract
Population structure and lifestyles may have contributed to the epidemiological status of Chronic Kidney Disease due to Type 2 Diabetes (CKD-T2D). This study is a secondary data analysis. Using data from the Global Burden of Disease Study, we describe the changes in CKD-T2D burden and its influencing factors in the population aged 20-59 years from 1990 to 2019. Globally, the incidence, death, and Disability Adjusted Life Years (DALYs) rate of CKD-T2D showed an upward trend and increased with age, and the burden in males was higher than that in females. Population growth and aging were important driving factors for the increase of CKD-T2D DALY burden, while high systolic blood pressure and high body-mass index were the primary attributable risk factors. High body-mass index exhibited higher contributions to high Socioeconomic Development Index (SDI) countries, whereas low SDI countries were more impacted by high systolic blood pressure. The population attributable fraction of CKD-T2D DALY caused by high body-mass index was positively correlated with SDI, while high temperature and lead exposure were negatively correlated. Therefore, strengthening disease screening for people aged 20-59 years and formulating early intervention measures based on the level of socioeconomic development may effectively alleviate the burden of CKD-T2D.
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Affiliation(s)
- Dandan Xie
- College of Traditional Chinese Medicine, International Advanced Functional Omics Platform, Scientific Experiment Center, Hainan Medical University, No. 3, Xueyuan Road, Haikou, 571199, Hainan, China
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Health Management Center and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, No. 139, Renmin Road, Changsha, 410011, Hunan, China
- Department of Clinical Nutrition, The First Affiliated Hospital of Hainan Medical University, No. 31, Longhua Road, Haikou, 570102, Hainan, China
| | - Tianpeng Ma
- College of Traditional Chinese Medicine, International Advanced Functional Omics Platform, Scientific Experiment Center, Hainan Medical University, No. 3, Xueyuan Road, Haikou, 571199, Hainan, China
| | - Haoliang Cui
- School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Jing Li
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Health Management Center and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, No. 139, Renmin Road, Changsha, 410011, Hunan, China
| | - Aihua Zhang
- College of Traditional Chinese Medicine, International Advanced Functional Omics Platform, Scientific Experiment Center, Hainan Medical University, No. 3, Xueyuan Road, Haikou, 571199, Hainan, China.
| | - Zhifeng Sheng
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Health Management Center and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, No. 139, Renmin Road, Changsha, 410011, Hunan, China.
| | - Yiqiang Xie
- College of Traditional Chinese Medicine, International Advanced Functional Omics Platform, Scientific Experiment Center, Hainan Medical University, No. 3, Xueyuan Road, Haikou, 571199, Hainan, China.
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Rios P, Silvariño R, Sola L, Ferreiro A, Lamadrid V, Fajardo L, Gadola L. Mineral and bone disorder and longterm survival in a chronic kidney disease grade 3b-4cohort. Ren Fail 2022; 44:1356-1367. [PMID: 35946486 PMCID: PMC9373789 DOI: 10.1080/0886022x.2022.2107543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/13/2022] [Accepted: 07/24/2022] [Indexed: 11/13/2022] Open
Abstract
Mineral and bone disorder biomarkers 'normal ranges' are controversial. The aim of the study was to evaluate the association between serum calcium (Ca), phosphate (P), intact parathyroid hormone (iPTH), and 25(OH) vitamin D levels and mortality risk, in a chronic kidney disease (CKD) grade (G) 3b-4 cohort. The Uruguayan National Renal Healthcare Program (NRHP-UY) CKD patients' cohort, included between 1 October 2004 and 1 March 2020 and followed-up until 1 March 2021, was analyzed with the Ethics Committee approval. A total of 6473 patients were analyzed: 56% men, median age 73 (65-79) years, 55% on CKD G3b. At the end of the follow-up, 2459 (37.7%) patients had died (6.4/100 patient-year). There were iPTH data on 2013 patients (younger, with lower estimated glomerular filtration rate (eGFR) and lesser comorbidities). By bivariate Cox analysis the lowest death risk was observed with mean Ca between 9.01 and 10.25 mg/dl, P between 2.76 and 4.0 mg/dl, iPTH ≤ 105 pg/ml, and 25(OH) vitamin D >10 ng/ml. The multivariate Cox regression mortality risk adjusted to age, sex, CKD etiology, diabetes, smoking, cardiovascular comorbidity, blood pressure, proteinuria, eGFR, renin-angiotensin system blockers and vitamin D treatments, serum Ca, P, iPTH, and 25(OH) vitamin D (n = 964) showed that a higher mortality risk was associated with p > 4.00 mg/dl (HR 1.668, CI 95%: 1.201-2.317), iPTH >105 pg/ml (HR 1.386, CI 95%: 1.012-1.989), and 25(OH) vitamin D ≤ 10 ng/ml (HR 1.958, CI 95%: 1.238-3.098) and a lower mortality risk with 1,25(OH)2 vitamin D treatment (HR 0.639, CI 95%: 0.451-0.906). These data may contribute to the precise G3b-4 CKD-MBD biomarkers levels definition.
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Affiliation(s)
- Pablo Rios
- Comisión Asesora Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay
| | - Ricardo Silvariño
- Comisión Asesora Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay
- Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Laura Sola
- Comisión Asesora Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay
| | - Alejandro Ferreiro
- Comisión Asesora Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay
- Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Verónica Lamadrid
- Comisión Asesora Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay
| | - Laura Fajardo
- Sociedad Uruguaya de Nefrología, Montevideo, Uruguay
| | - Liliana Gadola
- Comisión Asesora Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay
- Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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Molina P, Molina MD, Pallardó LM, Torralba J, Escudero V, Álvarez L, Peris A, Sánchez-Pérez P, González-Rico M, Puchades MJ, Fernández-Nájera JE, Giménez-Civera E, D'Marco L, Carrero JJ, Górriz JL. Disorders in bone-mineral parameters and the risk of death in persons with chronic kidney disease stages 4 and 5: the PECERA study. J Nephrol 2021; 34:1189-1199. [PMID: 33394344 DOI: 10.1007/s40620-020-00916-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/11/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Abnormalities of bone mineral parameters are associated with increased mortality in patients on dialysis, but their effects and the optimal range of these biomarkers are less well characterized in non-dialysis chronic kidney disease (CKD). METHODS PECERA (Collaborative Study Project in Patients with Advanced CKD) is a 3-year, prospective multicenter, open-cohort study of 966 adult patients with non-dialyzed CKD stages 4-5 enrolled from 12 centers in Spain. Associations between levels of serum calcium (Ca) (corrected for albumin), phosphate (P), and intact parathyroid hormone (iPTH) with all-cause mortality (primary outcome) and cardiovascular mortality (secondary outcome) were examined using time-dependent Cox proportional hazards models and penalized splines analysis adjusted by demographics and comorbidities, treatments and biochemical values collected every 6 months for 3 years. RESULTS After a median follow-up of 29 months (IQR: 13-36 months) there were 181 deaths (19%). The association of calcium with all-cause mortality was J-shaped, with an increased risk for all-cause mortality at levels > 10.5 mg/dL. For phosphate and iPTH levels, the association was U-shaped. The serum values associated with the minimum risk of mortality were 3.8 mg/dL for phosphate and 70 pg/mL for iPTH, being the lowest risk ranges between 2.8 and 5.0 mg/dL, and between 38 and 112 pg/mL for phosphate and iPTH, respectively. CONCLUSIONS Our study provides evidence on the non-linear association of serum calcium, phosphate and iPTH levels with mortality in stage 4 and 5 CKD patients, and suggests potential survival benefits for controlling bone mineral parameters in this population, as previously reported for dialysis patients.
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Affiliation(s)
- Pablo Molina
- Department of Nephrology, Hospital Universitari Dr Peset, FISABIO, Avda. Gaspar Aguilar, 90, 46017, Valencia, Spain.
- Department of Medicine, Universitat de València, Valencia, Spain.
| | - Mariola D Molina
- Department of Mathematics, Universidad de Alicante, Alicante, Spain
| | - Luis M Pallardó
- Department of Nephrology, Hospital Universitari Dr Peset, FISABIO, Avda. Gaspar Aguilar, 90, 46017, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Javier Torralba
- Department of Nephrology, Hospital General Universitario, Alicante, Spain
| | - Verónica Escudero
- Department of Nephrology, Hospital Universitari Dr Peset, FISABIO, Avda. Gaspar Aguilar, 90, 46017, Valencia, Spain
| | - Luis Álvarez
- Section of Nephrology, Hospital Virgen de Los Lirios, Alcoi, Spain
| | - Ana Peris
- Department of Nephrology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pilar Sánchez-Pérez
- Department of Nephrology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Miguel González-Rico
- Department of Nephrology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - María J Puchades
- Department of Nephrology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | | | - Elena Giménez-Civera
- Department of Nephrology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - Luis D'Marco
- Department of Nephrology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - Juan J Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - José L Górriz
- Department of Medicine, Universitat de València, Valencia, Spain
- Department of Nephrology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
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Cheng D, Tang Y, Li H, Li Y, Sang H. Nighttime blood pressure decline as a predictor of renal injury in patients with hypertension: a population-based cohort study. Aging (Albany NY) 2020; 11:4310-4322. [PMID: 31276448 PMCID: PMC6660036 DOI: 10.18632/aging.101873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/10/2019] [Indexed: 01/02/2023]
Abstract
We explored whether the nighttime blood pressure (BP) decline predicts renal function decline in a population-based cohort with primary hypertension. We measured the baseline ambulatory BP and glomerular filtration rate (GFR) in a cohort of 1,042 primary hypertensive patients. We repeated the GFR measurements and calculated the rate of GFR decline after a median follow-up of 5.8 years. The estimated GFR (eGFR) declined by -0.23 to -0.20 mL/min per year as the nighttime systolic BP (SBP), diastolic BP (DBP), and mean BP decline rates increased by 1% (P < 0.001). In the fully adjusted model, the nighttime SBP, DBP, and mean BP were all related to a steeper rate of eGFR decline by -0.25 to -0.22 mL/min per 1% increase. The adjusted multivariable results indicated that the odds of an eGFR decline were reduced by 46% when the nighttime SBP decline rate increased by 1% (OR= 0.54, 95% CI: 0.46-0.62). The restricted cubic spline model indicated a non-linear dose-response relationship with the nighttime SBP, DBP, and mean BP. Nighttime BP may be an important biomarker of renal function injury in hypertensive patients.
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Affiliation(s)
- Dong Cheng
- Department of Cardiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Yi Tang
- Department of Cardiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Haiyu Li
- Department of Cardiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Yunpeng Li
- Department of Cardiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Haiqiang Sang
- Department of Cardiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
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Rubinsztajn A, Fouque D. Prolyl-hydroxylase domain inhibitors in chronic kidney disease, a promising alternative for erythropoiesis-stimulating agent. Eur J Intern Med 2020; 76:28-30. [PMID: 32327320 DOI: 10.1016/j.ejim.2020.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/06/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022]
Affiliation(s)
- A Rubinsztajn
- Division of Nephrology, Nutrition, Dialysis; Hôpital Lyon Sud, Hospices Civils de Lyon, Université de Lyon, F-69495 Pierre Bénite, France
| | - D Fouque
- Division of Nephrology, Nutrition, Dialysis; Hôpital Lyon Sud, Hospices Civils de Lyon, Université de Lyon, F-69495 Pierre Bénite, France
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Rastogi A, Bhatt N, Rossetti S, Beto J. Management of Hyperphosphatemia in End-Stage Renal Disease: A New Paradigm. J Ren Nutr 2020; 31:21-34. [PMID: 32386937 DOI: 10.1053/j.jrn.2020.02.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/27/2020] [Accepted: 02/08/2020] [Indexed: 12/12/2022] Open
Abstract
Bone and mineral metabolism becomes dysregulated with progression of chronic kidney disease (CKD), and increasing levels of parathyroid hormone serve as an adaptive response to maintain normal phosphorus and calcium levels. In end-stage renal disease, this response becomes maladaptive and high levels of phosphorus may occur. We summarize strategies to control hyperphosphatemia based on a systematic literature review of clinical trial and real-world observational data on phosphorus control in hemodialysis patients with CKD-mineral bone disorder (CKD-MBD). These studies suggest that current management options (diet and lifestyle changes; regular dialysis treatment; and use of phosphate binders, vitamin D, calcimimetics) have their own benefits and limitations with variable clinical outcomes. A more integrated approach to phosphorus control in dialysis patients may be necessary, incorporating measurement of multiple biomarkers of CKD-MBD pathophysiology (calcium, phosphorus, and parathyroid hormone) and correlation between diet adjustments and CKD-MBD drugs, which may facilitate improved patient management.
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Affiliation(s)
- Anjay Rastogi
- David Geffen School of Medicine at UCLA, Los Angeles, California.
| | - Nisha Bhatt
- Division of Nephrology, Department of Medical Affairs, Amgen Inc., Thousand Oaks, California
| | - Sandro Rossetti
- Division of Nephrology, Department of Medical Affairs, Amgen Inc., Thousand Oaks, California
| | - Judith Beto
- Division of Nephrology and Hypertension, Loyola University Chicago, Maywood, Illinois
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