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Meuleman Y, van der Bent Y, Gentenaar L, Caskey FJ, Bart HA, Konijn WS, Bos WJW, Hemmelder MH, Dekker FW. Exploring Patients' Perceptions About Chronic Kidney Disease and Their Treatment: A Qualitative Study. Int J Behav Med 2024; 31:263-275. [PMID: 37226037 PMCID: PMC10208195 DOI: 10.1007/s12529-023-10178-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Unhelpful illness perceptions can be changed by means of interventions and can lead to improved outcomes. However, little is known about illness perceptions in patients with chronic kidney disease (CKD) prior to kidney failure, and no tools exist in nephrology care to identify and support patients with unhelpful illness perceptions. Therefore, this study aims to: (1) identify meaningful and modifiable illness perceptions in patients with CKD prior to kidney failure; and (2) explore needs and requirements for identifying and supporting patients with unhelpful illness perceptions in nephrology care from patients' and healthcare professionals' perspectives. METHODS Individual semi-structured interviews were conducted with purposive heterogeneous samples of Dutch patients with CKD (n = 17) and professionals (n = 10). Transcripts were analysed using a hybrid inductive and deductive approach: identified themes from the thematic analysis were hereafter organized according to Common-Sense Model of Self-Regulation principles. RESULTS Illness perceptions considered most meaningful are related to the seriousness (illness identity, consequences, emotional response and illness concern) and manageability (illness coherence, personal control and treatment control) of CKD. Over time, patients developed more unhelpful seriousness-related illness perceptions and more helpful manageability-related illness perceptions, caused by: CKD diagnosis, disease progression, healthcare support and approaching kidney replacement therapy. Implementing tools to identify and discuss patients' illness perceptions was considered important, after which support for patients with unhelpful illness perceptions should be offered. Special attention should be paid towards structurally embedding psychosocial educational support for patients and caregivers to deal with CKD-related symptoms, consequences, emotions and concerns about the future. CONCLUSIONS Several meaningful and modifiable illness perceptions do not change for the better by means of nephrology care. This underlines the need to identify and openly discuss illness perceptions and to support patients with unhelpful illness perceptions. Future studies should investigate whether implementing illness perception-based tools will indeed improve outcomes in CKD.
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Affiliation(s)
- Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands.
| | - Yvonne van der Bent
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Leandra Gentenaar
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Fergus J Caskey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Hans Aj Bart
- Dutch Kidney Patients Association, Bussum, the Netherlands
| | - Wanda S Konijn
- Dutch Kidney Patients Association, Bussum, the Netherlands
| | - Willem Jan W Bos
- Department of Nephrology, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Marc H Hemmelder
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- CARIM School for Cardiovascular Research, University Maastricht, Maastricht, the Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
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Milders J, Ramspek CL, Janse RJ, Bos WJW, Rotmans JI, Dekker FW, van Diepen M. Prognostic Models in Nephrology: Where Do We Stand and Where Do We Go from Here? Mapping Out the Evidence in a Scoping Review. J Am Soc Nephrol 2024; 35:367-380. [PMID: 38082484 PMCID: PMC10914213 DOI: 10.1681/asn.0000000000000285] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
Prognostic models can strongly support individualized care provision and well-informed shared decision making. There has been an upsurge of prognostic research in the field of nephrology, but the uptake of prognostic models in clinical practice remains limited. Therefore, we map out the research field of prognostic models for kidney patients and provide directions on how to proceed from here. We performed a scoping review of studies developing, validating, or updating a prognostic model for patients with CKD. We searched all published models in PubMed and Embase and report predicted outcomes, methodological quality, and validation and/or updating efforts. We found 602 studies, of which 30.1% concerned CKD populations, 31.6% dialysis populations, and 38.4% kidney transplantation populations. The most frequently predicted outcomes were mortality ( n =129), kidney disease progression ( n =75), and kidney graft survival ( n =54). Most studies provided discrimination measures (80.4%), but much less showed calibration results (43.4%). Of the 415 development studies, 28.0% did not perform any validation and 57.6% performed only internal validation. Moreover, only 111 models (26.7%) were externally validated either in the development study itself or in an independent external validation study. Finally, in 45.8% of development studies no useable version of the model was reported. To conclude, many prognostic models have been developed for patients with CKD, mainly for outcomes related to kidney disease progression and patient/graft survival. To bridge the gap between prediction research and kidney patient care, patient-reported outcomes, methodological rigor, complete reporting of prognostic models, external validation, updating, and impact assessment urgently need more attention.
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Affiliation(s)
- Jet Milders
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Chava L. Ramspek
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Roemer J. Janse
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem Jan W. Bos
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Santeon, Utrecht, The Netherlands
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Joris I. Rotmans
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Friedo W. Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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Spasiano A, Benedetti C, Gambaro G, Ferraro PM. Predictive models in chronic kidney disease: essential tools in clinical practice. Curr Opin Nephrol Hypertens 2024; 33:238-246. [PMID: 37937547 DOI: 10.1097/mnh.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
PURPOSE OF REVIEW The integration of risk prediction in managing chronic kidney disease (CKD) is universally considered a key point of routine clinical practice to guide time-sensitive choices, such as dialysis access planning or counseling on kidney transplant options. Several prognostic models have been developed and validated to provide individualized evaluation of kidney failure risk in CKD patients. This review aims to analyze the current evidence on existing predictive models and evaluate the different advantages and disadvantages of these tools. RECENT FINDINGS Since Tangri et al. introduced the Kidney Failure Risk Equation in 2011, the nephrological scientific community focused its interest in enhancing available algorithms and finding new prognostic equations. Although current models can predict kidney failure with high discrimination, different questions remain unsolved. Thus, this field is open to new possibilities and discoveries. SUMMARY Accurately informing patients of their prognoses can result in tailored therapy with important clinical and psychological implications. Over the last 5 years, the number of disease-modifying therapeutic options has considerably increased, providing possibilities to not only prevent the kidney failure onset in patients with advanced CKD but also delay progression from early stages in at-risk individuals.
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Affiliation(s)
- Andrea Spasiano
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome
| | - Claudia Benedetti
- Nephrology and dialysis, "San Bassiano Hospital", Bassano del Grappa
| | - Giovanni Gambaro
- Section of Nephrology, Università degli Studi di Verona, Ospedale Maggiore, Verona, Italy
| | - Pietro Manuel Ferraro
- Section of Nephrology, Università degli Studi di Verona, Ospedale Maggiore, Verona, Italy
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Haaskjold YL, Lura NG, Bjørneklett R, Bostad LS, Knoop T, Bostad L. Long-term follow-up of IgA nephropathy: clinicopathological features and predictors of outcomes. Clin Kidney J 2023; 16:2514-2522. [PMID: 38046027 PMCID: PMC10689167 DOI: 10.1093/ckj/sfad154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Indexed: 12/05/2023] Open
Abstract
Background The establishment of the Oxford classification and newly developed prediction models have improved the prognostic information for immunoglobulin A nephropathy (IgAN). Considering new treatment options, optimizing prognostic information and improving existing prediction models are favorable. Methods We used random forest survival analysis to select possible predictors of end-stage kidney disease among 37 candidate variables in a cohort of 232 patients with biopsy-proven IgAN retrieved from the Norwegian Kidney Biopsy Registry. The predictive value of variables with relative importance >5% was assessed using concordance statistics and the Akaike information criterion. Pearson's correlation coefficient was used to identify correlations between the selected variables. Results The median follow-up period was 13.7 years. An isolated analysis of histological variables identified six variables with relative importance >5%: T %, segmental glomerular sclerosis without characteristics associated with other subtypes (not otherwise specified, NOS), normal glomeruli, global sclerotic glomeruli, segmental adherence and perihilar glomerular sclerosis. When histopathological and clinical variables were combined, estimated glomerular filtration rate (eGFR), proteinuria and serum albumin were added to the list. T % showed a better prognostic value than tubular atrophy/interstitial fibrosis (T) lesions with C-indices at 0.74 and 0.67 and was highly correlated with eGFR. Analysis of the subtypes of segmental glomerulosclerosis (S) lesions revealed that NOS and perihilar glomerular sclerosis were associated with adverse outcomes. Conclusions Reporting T lesions as a continuous variable, normal glomeruli and subtypes of S lesions could provide clinicians with additional prognostic information and contribute to the improved performance of the Oxford classification and prognostic tools.
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Affiliation(s)
- Yngvar Lunde Haaskjold
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Renal Research Group, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Njål Gjærde Lura
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Rune Bjørneklett
- Renal Research Group, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
| | - Lars Sigurd Bostad
- Renal Research Group, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
| | - Thomas Knoop
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Renal Research Group, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Leif Bostad
- Renal Research Group, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
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Russo GT, Giandalia A, Ceriello A, Di Bartolo P, Di Cianni G, Fioretto P, Giorda CB, Manicardi V, Pontremoli R, Viazzi F, Lucisano G, Nicolucci A, De Cosmo S. A prediction model to assess the risk of egfr loss in patients with type 2 diabetes and preserved kidney function: The amd annals initiative. Diabetes Res Clin Pract 2022; 192:110092. [PMID: 36167264 DOI: 10.1016/j.diabres.2022.110092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/05/2022] [Accepted: 09/19/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To develop and validate a model for predicting 5-year eGFR-loss in type 2 diabetes mellitus (T2DM) patients with preserved renal function at baseline. RESEARCH DESIGN AND METHODS A cohort of 504.532 T2DM outpatients participating to the Medical Associations of Diabetologists (AMD) Annals Initiative was splitted into the Learning and Validation cohorts, in which the predictive model was respectively developed and validated. A multivariate Cox proportional hazard regression model including all baseline characteristics was performed to identify predictors of eGFR-loss. A weight derived from regression coefficients was assigned to each variable and the overall sum of weights determined the 0 to 8-risk score. RESULTS A set of demographic, clinical and laboratory parameters entered the final model. The eGFR-loss score showed a good performance in the Validation cohort. Increasing score values progressively identified a higher risk of GFR loss: a score ≥ 8 was associated with a HR of 13.48 (12.96-14.01) in the Learning and a HR of 13.45 (12.93-13.99) in the Validation cohort. The 5 years-probability of developing the study outcome was 55.9% higher in subjects with a score ≥ 8. CONCLUSIONS In the large AMD Annals Initiative cohort, we developed and validated an eGFR-loss prediction model to identify T2DM patients at risk of developing clinically meaningful renal complications within a 5-years time frame.
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Affiliation(s)
- G T Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - A Giandalia
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - A Ceriello
- Department of Cardiovascular and Metabolic Diseases, IRCCS Gruppo Multimedica, MI, Italy.
| | | | - G Di Cianni
- Diabetes and Metabolic Diseases Unit, Health Local Unit North-West Tuscany, Livorno, Italy.
| | - P Fioretto
- Department of Medicine, University of Padua, Unit of Medical Clinic 3, Hospital of Padua, Padua, Italy.
| | - C B Giorda
- Diabetes and Metabolism Unit ASL Turin 5 Chieri (TO), Italy.
| | - V Manicardi
- Diabetes Consultant, Salus Hospital, Reggio Emilia, Italy.
| | - R Pontremoli
- Università degli Studi and IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| | - F Viazzi
- Università degli Studi and IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| | - G Lucisano
- Center for Outcomes Research and Clinical Epidemiology, CORESEARCH, Pescara, Italy.
| | - A Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, CORESEARCH, Pescara, Italy.
| | - S De Cosmo
- Department of Medical Sciences, Scientific Institute "Casa Sollievo della Sofferenza", San Giovanni Rotondo (FG), Italy.
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Shi X, Qu T, Van Pottelbergh G, van den Akker M, De Moor B. A Resampling Method to Improve the Prognostic Model of End-Stage Kidney Disease: A Better Strategy for Imbalanced Data. Front Med (Lausanne) 2022; 9:730748. [PMID: 35321465 PMCID: PMC8935060 DOI: 10.3389/fmed.2022.730748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 01/17/2022] [Indexed: 12/12/2022] Open
Abstract
Background Prognostic models can help to identify patients at risk for end-stage kidney disease (ESKD) at an earlier stage to provide preventive medical interventions. Previous studies mostly applied the Cox proportional hazards model. The aim of this study is to present a resampling method, which can deal with imbalanced data structure for the prognostic model and help to improve predictive performance. Methods The electronic health records of patients with chronic kidney disease (CKD) older than 50 years during 2005–2015 collected from primary care in Belgium were used (n = 11,645). Both the Cox proportional hazards model and the logistic regression analysis were applied as reference model. Then, the resampling method, the Synthetic Minority Over-Sampling Technique-Edited Nearest Neighbor (SMOTE-ENN), was applied as a preprocessing procedure followed by the logistic regression analysis. The performance was evaluated by accuracy, the area under the curve (AUC), confusion matrix, and F3 score. Results The C statistics for the Cox proportional hazards model was 0.807, while the AUC for the logistic regression analysis was 0.700, both on a comparable level to previous studies. With the model trained on the resampled set, 86.3% of patients with ESKD were correctly identified, although it was at the cost of the high misclassification rate of negative cases. The F3 score was 0.245, much higher than 0.043 for the logistic regression analysis and 0.022 for the Cox proportional hazards model. Conclusion This study pointed out the imbalanced data structure and its effects on prediction accuracy, which were not thoroughly discussed in previous studies. We were able to identify patients with high risk for ESKD better from a clinical perspective by using the resampling method. But, it has the limitation of the high misclassification of negative cases. The technique can be widely used in other clinical topics when imbalanced data structure should be considered.
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Affiliation(s)
- Xi Shi
- Department of Electrical Engineering (ESAT), Stadius Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
- Vlerick Business School, Leuven, Belgium
- *Correspondence: Xi Shi
| | - Tingyu Qu
- Department of Computer Science, KU Leuven, Leuven, Belgium
| | - Gijs Van Pottelbergh
- Department of Public Health and Primary Care, Academic Centre of General Practice, KU Leuven, Leuven, Belgium
| | - Marjan van den Akker
- Department of Public Health and Primary Care, Academic Centre of General Practice, KU Leuven, Leuven, Belgium
- Institute of General Practice, Goethe University, Frankfurt am Main, Germany
| | - Bart De Moor
- Department of Electrical Engineering (ESAT), Stadius Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
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Bellocchio F, Lonati C, Ion Titapiccolo J, Nadal J, Meiselbach H, Schmid M, Baerthlein B, Tschulena U, Schneider M, Schultheiss UT, Barbieri C, Moore C, Steppan S, Eckardt KU, Stuard S, Neri L. Validation of a Novel Predictive Algorithm for Kidney Failure in Patients Suffering from Chronic Kidney Disease: The Prognostic Reasoning System for Chronic Kidney Disease (PROGRES-CKD). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12649. [PMID: 34886378 PMCID: PMC8656741 DOI: 10.3390/ijerph182312649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/21/2021] [Accepted: 11/25/2021] [Indexed: 12/04/2022]
Abstract
Current equation-based risk stratification algorithms for kidney failure (KF) may have limited applicability in real world settings, where missing information may impede their computation for a large share of patients, hampering one from taking full advantage of the wealth of information collected in electronic health records. To overcome such limitations, we trained and validated the Prognostic Reasoning System for Chronic Kidney Disease (PROGRES-CKD), a novel algorithm predicting end-stage kidney disease (ESKD). PROGRES-CKD is a naïve Bayes classifier predicting ESKD onset within 6 and 24 months in adult, stage 3-to-5 CKD patients. PROGRES-CKD trained on 17,775 CKD patients treated in the Fresenius Medical Care (FMC) NephroCare network. The algorithm was validated in a second independent FMC cohort (n = 6760) and in the German Chronic Kidney Disease (GCKD) study cohort (n = 4058). We contrasted PROGRES-CKD accuracy against the performance of the Kidney Failure Risk Equation (KFRE). Discrimination accuracy in the validation cohorts was excellent for both short-term (stage 4-5 CKD, FMC: AUC = 0.90, 95%CI 0.88-0.91; GCKD: AUC = 0.91, 95% CI 0.86-0.97) and long-term (stage 3-5 CKD, FMC: AUC = 0.85, 95%CI 0.83-0.88; GCKD: AUC = 0.85, 95%CI 0.83-0.88) forecasting horizons. The performance of PROGRES-CKD was non-inferior to KFRE for the 24-month horizon and proved more accurate for the 6-month horizon forecast in both validation cohorts. In the real world setting captured in the FMC validation cohort, PROGRES-CKD was computable for all patients, whereas KFRE could be computed for complete cases only (i.e., 30% and 16% of the cohort in 6- and 24-month horizons). PROGRES-CKD accurately predicts KF onset among CKD patients. Contrary to equation-based scores, PROGRES-CKD extends to patients with incomplete data and allows explicit assessment of prediction robustness in case of missing values. PROGRES-CKD may efficiently assist physicians' prognostic reasoning in real-life applications.
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Affiliation(s)
- Francesco Bellocchio
- Clinical & Data Intelligence Systems-Advanced Analytics, Fresenius Medical Care Deutschland GmbH, 26020 Vaiano Cremasco, Italy; (J.I.T.); (L.N.)
| | - Caterina Lonati
- Center for Preclinical Research, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Jasmine Ion Titapiccolo
- Clinical & Data Intelligence Systems-Advanced Analytics, Fresenius Medical Care Deutschland GmbH, 26020 Vaiano Cremasco, Italy; (J.I.T.); (L.N.)
| | - Jennifer Nadal
- Department of Medical Biometry, Informatics, and Epidemiology (IMBIE), Faculty of Medicine, University of Bonn, 53113 Bonn, Germany; (J.N.); (M.S.); (M.S.)
| | - Heike Meiselbach
- Department of Nephrology and Hypertension, Friedrich-Alexander University of Erlangen-Nürnberg, 91054 Erlangen, Germany; (H.M.); (K.-U.E.)
| | - Matthias Schmid
- Department of Medical Biometry, Informatics, and Epidemiology (IMBIE), Faculty of Medicine, University of Bonn, 53113 Bonn, Germany; (J.N.); (M.S.); (M.S.)
| | - Barbara Baerthlein
- Medical Centre for Information and Communication Technology (MIK), University Hospital Erlangen, 91054 Erlangen, Germany;
| | - Ulrich Tschulena
- Fresenius Medical Care, Deutschland GmbH, 61352 Bad Homburg, Germany; (U.T.); (C.B.); (C.M.); (S.S.); (S.S.)
| | - Markus Schneider
- Department of Medical Biometry, Informatics, and Epidemiology (IMBIE), Faculty of Medicine, University of Bonn, 53113 Bonn, Germany; (J.N.); (M.S.); (M.S.)
| | - Ulla T. Schultheiss
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, 79085 Freiburg, Germany;
- Department of Medicine IV–Nephrology and Primary Care, Faculty of Medicine and Medical Center, University of Freiburg, 79085 Freiburg, Germany
| | - Carlo Barbieri
- Fresenius Medical Care, Deutschland GmbH, 61352 Bad Homburg, Germany; (U.T.); (C.B.); (C.M.); (S.S.); (S.S.)
| | - Christoph Moore
- Fresenius Medical Care, Deutschland GmbH, 61352 Bad Homburg, Germany; (U.T.); (C.B.); (C.M.); (S.S.); (S.S.)
| | - Sonja Steppan
- Fresenius Medical Care, Deutschland GmbH, 61352 Bad Homburg, Germany; (U.T.); (C.B.); (C.M.); (S.S.); (S.S.)
| | - Kai-Uwe Eckardt
- Department of Nephrology and Hypertension, Friedrich-Alexander University of Erlangen-Nürnberg, 91054 Erlangen, Germany; (H.M.); (K.-U.E.)
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Stefano Stuard
- Fresenius Medical Care, Deutschland GmbH, 61352 Bad Homburg, Germany; (U.T.); (C.B.); (C.M.); (S.S.); (S.S.)
| | - Luca Neri
- Clinical & Data Intelligence Systems-Advanced Analytics, Fresenius Medical Care Deutschland GmbH, 26020 Vaiano Cremasco, Italy; (J.I.T.); (L.N.)
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Slieker RC, van der Heijden AAWA, Siddiqui MK, Langendoen-Gort M, Nijpels G, Herings R, Feenstra TL, Moons KGM, Bell S, Elders PJ, 't Hart LM, Beulens JWJ. Performance of prediction models for nephropathy in people with type 2 diabetes: systematic review and external validation study. BMJ 2021; 374:n2134. [PMID: 34583929 PMCID: PMC8477272 DOI: 10.1136/bmj.n2134] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To identify and assess the quality and accuracy of prognostic models for nephropathy and to validate these models in external cohorts of people with type 2 diabetes. DESIGN Systematic review and external validation. DATA SOURCES PubMed and Embase. ELIGIBILITY CRITERIA Studies describing the development of a model to predict the risk of nephropathy, applicable to people with type 2 diabetes. METHODS Screening, data extraction, and risk of bias assessment were done in duplicate. Eligible models were externally validated in the Hoorn Diabetes Care System (DCS) cohort (n=11 450) for the same outcomes for which they were developed. Risks of nephropathy were calculated and compared with observed risk over 2, 5, and 10 years of follow-up. Model performance was assessed based on intercept adjusted calibration and discrimination (Harrell's C statistic). RESULTS 41 studies included in the systematic review reported 64 models, 46 of which were developed in a population with diabetes and 18 in the general population including diabetes as a predictor. The predicted outcomes included albuminuria, diabetic kidney disease, chronic kidney disease (general population), and end stage renal disease. The reported apparent discrimination of the 46 models varied considerably across the different predicted outcomes, from 0.60 (95% confidence interval 0.56 to 0.64) to 0.99 (not available) for the models developed in a diabetes population and from 0.59 (not available) to 0.96 (0.95 to 0.97) for the models developed in the general population. Calibration was reported in 31 of the 41 studies, and the models were generally well calibrated. 21 of the 64 retrieved models were externally validated in the Hoorn DCS cohort for predicting risk of albuminuria, diabetic kidney disease, and chronic kidney disease, with considerable variation in performance across prediction horizons and models. For all three outcomes, however, at least two models had C statistics >0.8, indicating excellent discrimination. In a secondary external validation in GoDARTS (Genetics of Diabetes Audit and Research in Tayside Scotland), models developed for diabetic kidney disease outperformed those for chronic kidney disease. Models were generally well calibrated across all three prediction horizons. CONCLUSIONS This study identified multiple prediction models to predict albuminuria, diabetic kidney disease, chronic kidney disease, and end stage renal disease. In the external validation, discrimination and calibration for albuminuria, diabetic kidney disease, and chronic kidney disease varied considerably across prediction horizons and models. For each outcome, however, specific models showed good discrimination and calibration across the three prediction horizons, with clinically accessible predictors, making them applicable in a clinical setting. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020192831.
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Affiliation(s)
- Roderick C Slieker
- Department of Epidemiology and Data Science, Amsterdam Public Health Institute, Amsterdam Cardiovascular Sciences Institute, Amsterdam UMC, Location VUmc, 1081 HV, Amsterdam, Netherlands
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Amber A W A van der Heijden
- Department of General Practice, Amsterdam Public Health Institute, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
| | - Moneeza K Siddiqui
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Marlous Langendoen-Gort
- Department of General Practice, Amsterdam Public Health Institute, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
| | - Giel Nijpels
- Department of General Practice, Amsterdam Public Health Institute, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
| | - Ron Herings
- Department of Epidemiology and Data Science, Amsterdam Public Health Institute, Amsterdam Cardiovascular Sciences Institute, Amsterdam UMC, Location VUmc, 1081 HV, Amsterdam, Netherlands
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
| | - Talitha L Feenstra
- Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
- Centre for Nutrition, Prevention and Health Services, Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Samira Bell
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Petra J Elders
- Department of General Practice, Amsterdam Public Health Institute, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
| | - Leen M 't Hart
- Department of Epidemiology and Data Science, Amsterdam Public Health Institute, Amsterdam Cardiovascular Sciences Institute, Amsterdam UMC, Location VUmc, 1081 HV, Amsterdam, Netherlands
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
- Molecular Epidemiology section, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Joline W J Beulens
- Department of Epidemiology and Data Science, Amsterdam Public Health Institute, Amsterdam Cardiovascular Sciences Institute, Amsterdam UMC, Location VUmc, 1081 HV, Amsterdam, Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Impacts of Interaction of Mental Condition and Quality of Life between Donors and Recipients at Decision-Making of Preemptive and Post-Dialysis Living-Donor Kidney Transplantation. J Pers Med 2021; 11:jpm11050414. [PMID: 34069298 PMCID: PMC8157173 DOI: 10.3390/jpm11050414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/08/2021] [Accepted: 05/13/2021] [Indexed: 12/24/2022] Open
Abstract
Pre-emptive kidney transplantation (PEKT) is considered one of the most effective types of kidney replacement therapies to improve the quality of life (QOL) and physical prognosis of patients with end-stage renal disease (ESRD). In Japan, living-donor kidney transplantation is a common therapeutic option for patients undergoing dialyses (PDKT). Moreover, during shared decision-making in kidney replacement therapy, the medical staff of the multidisciplinary kidney team often provide educational consultation programmes according to the QOL and sociopsychological status of the ESRD patient. In Japan, the majority of kidney donations are provided by living family members. However, neither the psychosocial status of donors associated with the decision-making of kidney donations nor the interactions of the psychosocial status between donors and recipients have been clarified in the literature. In response to this gap, the present study determined the QOL, mood and anxiety status of donors and recipients at kidney transplantation decision-making between PEKT and PDKT. Deterioration of the recipient's QOL associated with "role physical" shifted the decision-making to PEKT, whereas deterioration of QOL associated with "role emotional" and "social functioning" of the recipients shifted the decision-making to PDKT. Furthermore, increased tension/anxiety and depressive mood contributed to choosing PDKT, but increased confusion was dominantly observed in PEKT recipients. These direct impact factors for decision-making were secondarily regulated by the trait anxiety of the recipients. Unlike the recipients, the donors' QOL associated with vitality contributed to choosing PDKT, whereas the physical and mental health of the donors shifted the decision-making to PEKT. Interestingly, we also detected the typical features of PEKT donors, who showed higher tolerability against the trait anxiety of reactive tension/anxiety than PDKT donors. These results suggest that choosing between either PEKT or PDKT is likely achieved through the proactive support of family members as candidate donors, rather than the recipients. Furthermore, PDKT is possibly facilitated by an enrichment of the life-work-family balance of the donors. Therefore, multidisciplinary kidney teams should be aware of the familial psychodynamics between patients with ESRD and their family members during the shared decision-making process by continuing the educational consultation programmes for the kidney-replacement-therapy decision-making process.
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